Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.
Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.
J Voice. 2014 Mar;28(2):255-7. doi: 10.1016/j.jvoice.2013.08.018. Epub 2013 Dec 4.
This report describes neurosyphilis presenting as vocal fold paresis and velopharyngeal incompetence. This represents the first reported case of neurosyphilis presenting as a vagal neuropathy since 1963.
Case report.
Review of medical records and literature search.
The patient presented with voice changes and nasopharyngeal reflux of liquids. Examination showed a left vocal fold paresis and moderate velopharyngeal incompetence. Laryngeal electromyography revealed evidence of denervation, and neurologic evaluation showed bilateral Adie's pupils and a positive CSF VDRL. A remote history of syphilis treated with one intramuscular injection was obtained. The patient was treated with 6 weeks of penicillin and regained normal vocal function with minimal residual intermittent hypernasality.
Given the recent increase in the incidence of syphilis in the United States, this case serves as a reminder of the importance of including syphilis in the differential diagnosis of cranial neuropathies and the increasing likelihood of syphilis presenting to otolaryngology and speech pathology practices. Syphilis, a disease whose incidence had declined progressively for 60 years in the United States, is now resurgent and must be considered in the evaluation of patients presenting with unexplained cranial neuropathies.
本报告描述了一种以声带麻痹和软腭功能不全为表现的神经梅毒。这是自 1963 年以来首例报告的以迷走神经病变为表现的神经梅毒。
病例报告。
回顾病历和文献检索。
患者出现声音改变和液体经鼻咽反流。检查发现左侧声带麻痹和中度软腭功能不全。喉肌电图显示有去神经支配的证据，神经科评估显示双侧阿狄瞳孔和阳性脑脊液 VDRL。患者有梅毒的既往病史，曾接受过一次肌肉注射治疗。患者接受了 6 周的青霉素治疗，恢复了正常的发声功能，仅有间歇性轻微鼻音过度残留。
鉴于美国梅毒发病率的近期增加，本病例提醒我们，在颅神经病变的鉴别诊断中应包括梅毒，以及梅毒越来越有可能出现在耳鼻喉科和言语病理学实践中。梅毒是一种在美国已经连续 60 年呈下降趋势的疾病，现在正在重新出现，在评估出现不明原因颅神经病变的患者时必须考虑到它。
