Neurosyphilis manifesting with rapidly progressive dementia: report of three cases
Neurosyphilis manifesting with rapidly progressive dementia: report of three cases
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DOI：
10.1007/s10072-013-1531-5
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发表时间：
2013-11-01
影响因子：
3.3
通讯作者：
Monaco, S.
中科院分区：
文献类型：
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作者：
Stefani, A.;Riello, M.;Monaco, S.
神经梅毒是一种罕见的痴呆症的原因，其特征是快速进展的过程和精神症状。神经梅毒的诊断应怀疑存在一个全面的认知障碍，包括定向障碍，健忘症和严重损害的语言和判断和精神症状，如抑郁症，躁狂症和精神病，亚急性发作。更常见的是，神经梅毒的临床表现包括全身轻瘫（涉及人格、情感、反射、眼睛、感觉、智力和语言）。在临床怀疑，神经梅毒的诊断是由反应性脑脊液（CSF）-性病研究实验室确认。在这里，我们报告了三个人类免疫缺陷病毒（HIV）阴性的男性患者精神症状和迅速发展的痴呆症。虽然磁共振成像不能解决诊断，脑脊液检查是强制性的神经梅毒的诊断。其他诊断工具，如神经心理学和单光子发射计算机断层扫描支持诊断。我们发现及时的抗生素治疗可能会阻止疾病的进展。因此，即使在HIV阴性患者中，如果出现意想不到的精神症状并伴有快速发展的认知能力下降，也应始终考虑神经梅毒。
Neurosyphilis is rather an unusual cause of dementia characterized by a rapidly progressive course and psychiatric symptoms. Diagnosis of neurosyphilis should be suspected in the presence of a global cognitive impairment consisting in disorientation, amnesia and severe impairment of speech and judgement and psychiatric symptoms such as depression, mania and psychosis, with a subacute onset. More commonly, clinical manifestations of neurosyphilis include general PARESIS (involvement of Personality, Affect, Reflexes, Eye, Sensorium, Intellect and Speech). Upon clinical suspicion, diagnosis of neurosyphilis is confirmed by a reactive cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory. Here we report three Human Immunodeficiency Virus (HIV)-negative male patients presenting with psychiatric symptoms and a rapidly evolving dementia. Although magnetic resonance imaging did not address to diagnosis, CSF examination was mandatory in neurosyphilis diagnosis. Other diagnostic tools such as neuropsychology and single-photon emission computed tomography resulted supportive in the diagnosis. We showed that a prompt antibiotic treatment might stop disease progression. Therefore, neurosyphilis should be always considered even in HIV-negative patients in the presence of unexpected psychiatric symptoms accompanied by a rapidly evolving cognitive decline.