【摘要】 目的 分析神经梅毒的临床及MRI表现,提高鉴别诊断能力。方法 回顾性分析经临床确诊为神经梅毒的12例患者的临床及MRI资料。结果 12例患者中,脑膜血管型2例(16.7%),多为缺血性卒中表现,病程短,起病急,MRI主要表现为颅内广泛但分散的多发急性脑梗死。梅毒树胶肿型1例(8.3%),病程稍长,MRI主要表现为内脑凸面多发病灶伴周围明显的水肿带,增强病灶明显强化伴邻近脑膜强化。脑实质型9例(75%),主要表现为进行性认知障碍伴精神行为异常,MRI主要表现为双侧颞叶、海马萎缩伴信号异常,伴或不伴其他脑实质的异常信号,增强强化方式多样,可无强化、斑片状、条状强化。结论 神经梅毒的MRI表现多样,可表现为多发脑梗死、梅毒树胶肿或颞叶及海马的信号异常,充分认识各型MRI表现,有助于鉴别诊断,减少误诊率。更多还原

【Abstract】 Objective To analyze the clinical and MRI findings of neurosyphilis,and to improve the differential diagnosis.Methods Retrospective analysis of clinical and MRI data of 12 patients clinically diagnosed with neurosyphilis.Results Of the 12 patients,two cases(16.7%) of the meningeal vascular type,mostly with ischemic stroke manifestations,had a short course and rapid onset,and MRI mainly showed extensive but scattered intracranial multiple acute cerebral infarction.One case(8.3%) of the syphilitic dendritic type with a slightly prolonged course,MRI mainly showed multiple foci on the convex side of the entorhinal brain with a clear surrounding edematous zone,and enhanced foci with adjacent meningeal enhancement.Nine cases(75%) of the brain parenchymal type presented mainly with progressive cognitive impairment with psychobehavioral abnormalities.MRI mainly showed bilateral temporal lobe and hippocampal atrophy with signal abnormalities,with or without other abnormal signals in the brain parenchyma,with various enhancement patterns,which could be non-enhancing,patchy,or stripe-like enhancement.Conclusion The MRI findings of neurosyphilis are diverse,which can be manifested as multiple cerebral infarction,syphilitic dendritic,or abnormal signals in the temporal lobe and hippocampus.A full understanding of various types of MRI findings can help differential diagnosis and reduce the rate of misdiagnosis.更多还原