Takahashi M, Hasegawa O, Fujita H, Kishimoto H, Kosaka K
Department of Psychiatry, Yokohama City University School of Medicine, Japan.
No To Shinkei. 1992 Jul;44(7):645-8.
Although the incidence of neurosyphilis has declined dramatically after the World War II because of the development of antibiotics, it is recently increasing a little bit. There has been few reports on the neuroimaging of general paresis. We studied a fresh case of general paresis by X-ray CT (XCT), MRI and PET scans, and report the changes of neuroimages before and after the therapy. A 38-year-old man was admitted with disorientation, thought disorder and personality change. He also had insomnia and megalomania. There were neither obvious neurological signs nor particular changes of the XCT scan abnormalities on admission. His clinical symptoms were gradually worsened within three months, when the XCT and MRI scans showed moderate brain atrophy especially in the frontal and temporal lobes with mild dilatation of the lateral ventricles. In the PET study, the cerebral blood flow was decreased in the entire brain, especially in the frontal lobes, although the thalamus and the basal ganglia had normal levels. By immunological procedures and the cerebrospinal fluid (CSF) studies, the diagnosis of general paresis was made. He was treated with penicillin G and other antibiotics. In one year after his first therapy, many symptoms vanished. Although the cerebral atrophy was a little advanced, the cerebral blood flow was dramatically increased. As far as we know, this is the first PET study of general paresis before and after penicillin treatments.
尽管由于抗生素的发展，二战后神经梅毒的发病率急剧下降，但最近又略有上升。关于麻痹性痴呆神经影像学的报道很少。我们通过X线计算机断层扫描（XCT）、磁共振成像（MRI）和正电子发射断层扫描（PET）对一例新鲜的麻痹性痴呆病例进行了研究，并报告了治疗前后神经影像的变化。一名38岁男性因定向障碍、思维紊乱和人格改变入院。他还伴有失眠和夸大狂。入院时既没有明显的神经系统体征，XCT扫描也没有特别的异常改变。在三个月内他的临床症状逐渐恶化，此时XCT和MRI扫描显示中度脑萎缩，尤其是额叶和颞叶，侧脑室轻度扩张。在PET研究中，全脑脑血流量减少，尤其是额叶，尽管丘脑和基底神经节水平正常。通过免疫学检查和脑脊液（CSF）研究，确诊为麻痹性痴呆。他接受了青霉素G和其他抗生素治疗。首次治疗一年后，许多症状消失。尽管脑萎缩有所进展，但脑血流量显著增加。据我们所知，这是第一例关于青霉素治疗前后麻痹性痴呆的PET研究。
