Department of Neurology and Neurogenetics "B", Université Mohamed V Souissi, 10010 Rabat, Morocco.
Department of Neurology and Neurogenetics "B", Université Mohamed V Souissi, 10010 Rabat, Morocco.
Rev Neurol (Paris). 2018 May;174(5):313-318. doi: 10.1016/j.neurol.2017.07.014. Epub 2018 Apr 7.
The aim of this study was to describe the clinical, biological and radiological characteristics of patients with syphilitic vasculitis, and to assess the outcome after treatment.
A retrospective review was carried out based on the records of patients with ischemic stroke, and reactive CSF TPHA and VDRL results. None of these patients showed symptoms of any other diseases or had received high doses of penicillin.
A total of 53 patients with stroke met the diagnostic criteria for syphilitic arteritis. Their average age was 41±12 years. Nine patients had a history of genital ulcer (17%), and the median duration of illness after presenting a chancre was 8 [range: 1-14] years. A prodromal syndrome was seen in 27 patients (50.9%) and included changes in mental status in 14 patients (26.4%), seizures in 10 cases (18.9%), headache in eight (15.1%) and memory loss in seven (13.2%). Neurological events included focal motor deficits in 29 cases (54.7%), ataxia in 11 (20.8%) and movement disorders in 15 (28.3%). HIV serology was performed in 31 patients and proved negative in every case. Disease evolution was generally favorable: 12 patients (22.6%) were autonomous at the time of hospital discharge; 29 (54.7%) had partially recovered; and only seven (13.2%) still had signs of severe sequelae.
A diagnosis of syphilitic stroke should be suspected in young patients as a manifestation of syphilis, and tests for neurosyphilis should be routine in neurology departments to make a prompt diagnosis, thereby preventing psychological sequelae.
本研究旨在描述梅毒性血管炎患者的临床、生物学和放射学特征，并评估治疗后的结果。
基于缺血性卒中患者的记录和反应性 CSF TPHA 和 VDRL 结果进行回顾性研究。这些患者均无其他疾病的症状或未接受大剂量青霉素治疗。
共有 53 例符合梅毒性动脉炎诊断标准的卒中患者。他们的平均年龄为 41±12 岁。9 例有生殖器溃疡病史（17%），从出现下疳到出现症状的中位时间为 8 [范围：1-14] 年。27 例（50.9%）出现前驱综合征，包括 14 例（26.4%）精神状态改变、10 例（18.9%）癫痫发作、8 例（15.1%）头痛和 7 例（13.2%）记忆丧失。神经事件包括 29 例（54.7%）局灶性运动功能障碍、11 例（20.8%）共济失调和 15 例（28.3%）运动障碍。对 31 例患者进行了 HIV 血清学检查，结果均为阴性。疾病的演变总体上是有利的：12 例（22.6%）在出院时能够自主活动；29 例（54.7%）部分恢复；只有 7 例（13.2%）仍有严重后遗症的迹象。
对于表现为梅毒的年轻患者，应怀疑梅毒性卒中的诊断，并应在神经科常规进行神经梅毒检查，以便及时做出诊断，从而预防心理后遗症。
