Tombor László, Salacz Pál, Jankelovics Éva, Hidasi Zoltán
Pszichiátriai és Pszichoterápiás Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Balassa u. 6., 1083.
Jelenlegi munkahely: Neurológiai Osztály, Fővárosi Önkormányzat Péterfy Sándor Utcai Kórház és Rendelőintézet Budapest.
Orv Hetil. 2018 Feb;159(6):234-238. doi: 10.1556/650.2018.30971.
The authors present a case of neurosyphilis associated with predominant psychiatric symptoms. The elderly man was admitted because of confused behavior, maniform state, lack of critical judgement and grandiose delusions. On admission, right central facial nerve paresis, hand tremor and parkinsonism were also found. Acute brain imaging and routine laboratory tests failed to identify a firm etiology of the confusional state. The psychiatric treatment resulted in complete recovery from delirium. Afterwards, maniform psychosis dominated the clinical picture for which antipsychotics were administered. Later, rapid cognitive deterioration and progression of motor symptoms were observed. MRI revealed cortical and hippocampal atrophy and white matter hyperintensities. Lumbar puncture found pleocytosis and elevated cerebrospinal fluid protein levels. Neurosyphilis had been confirmed by serologic tests. The cognitive symptoms improved and the psychiatric symptoms remitted under penicillin treatment. Four years after diagnosis, there is a gradual progression in the cognitive decline. Two additional hospitalizations were necessary due to the relapses of psychiatric symptoms. Orv Hetil. 2018; 159(6): 234-238.
作者报告了一例以精神症状为主的神经梅毒病例。该老年男性因行为混乱、类躁狂状态、缺乏批判性判断力和夸大妄想入院。入院时，还发现右侧中枢性面神经麻痹、手部震颤和帕金森症。急性脑成像和常规实验室检查未能确定意识混乱状态的确切病因。精神科治疗使谵妄完全康复。此后，类躁狂性精神病成为主要临床表现，为此给予了抗精神病药物治疗。后来，观察到认知功能迅速恶化和运动症状进展。MRI显示皮质和海马萎缩以及白质高信号。腰椎穿刺发现细胞增多和脑脊液蛋白水平升高。血清学检查确诊为神经梅毒。在青霉素治疗下，认知症状改善，精神症状缓解。诊断四年后，认知功能下降逐渐进展。由于精神症状复发，还需要两次住院治疗。《匈牙利医学周报》。2018年；159(6):234 - 238。
