Neurosyphilis in the elderly
Introduction
Introduction to neurosyphilis in the elderly Neurosyphilis is a disease caused by infection with Treponema pallidum, which was almost eliminated after the founding of New China. In recent years, the incidence of systemic syphilis has risen rapidly, so the reproduction and increase of neurosyphilis should be fully prepared. basic knowledge The proportion of sickness: 0.00001% Susceptible people: the elderly Mode of transmission: blood-borne transmission Complications: epilepsy optic atrophy dementia cerebral infarction
Cause
The cause of neurosyphilis in the elderly
(1) Causes of the disease
Neurosyphilis is caused by the invasion of the central nervous system by Treponema pallidum.
(two) pathogenesis
Invasion of the central system of Treponema pallidum can cause pathological damage to the corresponding parts, invading the meninges, causing inflammatory reactions, thickening of the meninges, and the most obvious lesions in the brain, involving the cerebral blood vessels and spinal cord arteries, which can cause thrombosis of the corresponding arteries. Brain or spinal cord infarction, it can also directly invade the brain and spinal cord tissue, causing degeneration and necrosis of nerve cells, brain atrophy, especially easy to invade the spinal cord and the posterior root, resulting in degeneration and atrophy.
Prevention
Elderly syphilis prevention
It is strictly forbidden to use condoms. When suffering from other sexually transmitted diseases, routine syphilis serum reaction should be checked. Sexual partners of syphilis should be observed regularly. Pre-marital physical examination should include routine syphilis serum reaction.
Complication
Elderly syphilis complications Complications epilepsy optic atrophy senile dementia cerebral infarction
Neurosyphilis often complicated by epilepsy, optic atrophy, senile dementia, and cerebral infarction.
Symptom
Symptoms of neurosyphilis in the elderly Common symptoms Dementia, sensory disturbance, sensory ataxia, nausea and vomiting, progressive dementia, genitourinary tract crisis, lightning-like pain, meningeal irritation
Symptoms, signs: due to pathology and disease course can be divided into the following common types:
Meninges and vascular syphilis
Acute syphilitic meningitis is acute, with obvious headache, vomiting and meningeal irritation. Late neurosyphilis meningitis often presents with acute or chronic onset. It is more common in meningitis of the skull base, brain is often affected, and meningeal meningitis is visible. Localized or systemic seizures, cerebral vascular syphilis mostly onset 2 to 10 years after infection, can invade any artery, manifested as acute neurological deficit in the affected arteries.
2. Myelitis and spinal vascular syphilis
Mainly manifested as acute or subacute transverse spinal cord injury.
3. Spinal cord fistula
It affects the posterior root of the spinal nerve and the posterior cord of the spinal cord. It is characterized by lightning pain in the lower limbs, deep sensory disturbance, sensory ataxia and bladder rectal dysfunction.
4. Progressive dementia
The clinical features of progressive dementia, early manifestations of personality changes, followed by recent memory disorders, judgment and computational power, lack of self-knowledge, and gradually entered dementia.
Examine
Elderly syphilis examination
Cerebrospinal fluid examination is usually lymphocyte-based leukocytosis, generally below 100 × 106 / L, protein increased, 0.5 ~ 1.5g / L, IgG and IgM can be increased.
Commonly used diagnostic tests for serum and cerebrospinal fluid syphilis are:
1. RL (venereal disease research laboratory) test is about 70% positive.
2. The specificity and sensitivity of the syphilis spiral antibody adsorption test is higher, 98% is positive.
Diagnosis
Diagnosis and diagnosis of neurosyphilis in the elderly
diagnosis
The diagnosis of neurosyphilis is based on the source of congenital or acquired syphilis, the above-mentioned clinical manifestations of the nervous system (if A. Roche's pupil is helpful for diagnosis), positive for serum and cerebrospinal fluid syphilis, and 3 for diagnosis. .
Differential diagnosis
Clinical should be differentiated from viral encephalitis, acute disseminated encephalomyelitis or toxic cerebral palsy.
