Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China.
J Neurol Sci. 2012 Jun 15;317(1-2):35-9. doi: 10.1016/j.jns.2012.03.003. Epub 2012 Apr 4.
Neurosyphilis is known as "the great imitator" or "the great impostor" because of its wide range of clinical symptoms. A high misdiagnosis rate of ischemic stroke was observed among neurosyphilis patients in clinical practice, which prevents patients from receiving the most appropriate treatment, and often results in more severe neurologic damage.
A total of 149 neurosyphilis patients were retrospectively reviewed. The control group comprised 1570 non-neurosyphilitic ischemic stroke patients. The proportion of patients with ischemic stroke as the primary symptom of the different types of neurosyphilis and the misdiagnosis rate of neurosyphilitic ischemic stroke were analyzed, including the risk factors for cardiovascular disease.
Among the 149 neurosyphilis patients, 21 (14.09%) developed ischemic stroke as a primary symptom, including three cases of syphilitic meningitis and 18 cases of meningovascular neurosyphilis. Only four of the neurosyphilis patients had histories of ischemic stroke and recurrence. The other 17 cases were treated for the first time in the emergency department; however, none of the patients were initially suspected of neurosyphilitic ischemic stroke. All of the patients were only diagnosed with neurosyphilis during their follow-up treatment. The misdiagnosis rate of neurosyphilitic ischemic stroke was as high as 80.95% (17/21). Furthermore, except for hypertension, no significant differences in cardiovascular risk factors were observed between the groups (P>0.05).
In clinical practice, particularly during emergencies, any ischemic stroke patient should be screened for neurosyphilis.
神经梅毒由于其广泛的临床症状，被称为“伟大的模仿者”或“伟大的骗子”。在临床实践中，神经梅毒患者的缺血性脑卒中误诊率很高，这使得患者无法接受最恰当的治疗，往往导致更严重的神经损伤。
回顾性分析了 149 例神经梅毒患者。对照组包括 1570 例非神经梅毒性缺血性脑卒中患者。分析了不同类型神经梅毒以缺血性脑卒中为首发症状的患者比例及神经梅毒性缺血性脑卒中的误诊率，包括心血管疾病的危险因素。
在 149 例神经梅毒患者中，21 例（14.09%）以缺血性脑卒中为首发症状，包括 3 例梅毒性脑膜炎和 18 例脑膜血管性神经梅毒。仅有 4 例神经梅毒患者有缺血性脑卒中病史和复发。其他 17 例在急诊科首次接受治疗；然而，这些患者均未最初被怀疑为神经梅毒性缺血性脑卒中。所有患者均在随访治疗中才被诊断为神经梅毒。神经梅毒性缺血性脑卒中的误诊率高达 80.95%（17/21）。此外，除高血压外，两组心血管危险因素无显著差异（P>0.05）。
在临床实践中，特别是在急诊时，任何缺血性脑卒中患者均应筛查神经梅毒。
