Gao Jun-Hua, Li Wu-Rong, Xu Dong-Mei, Zheng Bo-Wen, Huang Yu-Ming, Wu Wen-Qing, Zhang Wei
Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China.
Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Neuropsychiatr Dis Treat. 2021 Jan 13;17:69-78. doi: 10.2147/NDT.S279265. eCollection 2021.
We aim to study the clinical manifestations, fluid changes and neuroimaging alterations in patients with general paresis of the insane (GPI).
A total of 119 patients suffering from GPI recruited in Beijing Ditan Hospital, Capital Medical University from 2010 to 2020 were retrospectively analyzed.
In 119 GPI patients, 103 cases (86.6%) were male. Misdiagnosed rate was up to 83.2%, schizophrenia and mood disorders were the most common misdiagnosed diseases. Duration from symptom onset to the final confirmed diagnosis was 10.4±12.9 months. The main clinical manifestations included cognitive impairment (114 cases, 95.8%) and neuropsychiatric symptoms (107 cases, 90.0%). The cognitive domains including the delayed recall, visuospatial/executive function and language ability indicated by MoCA score were damaged severely. Rapid plasma regain (RPR) of all GPI patients was 100% positive in serum and 89.9% positive in cerebral spinal fluid (CSF). The white blood cell (WBC) number in CSF was between 6 and 50/μL in 73 GPI patients (61.3%). The protein level was between 45.1 and 70mg/dL in 47 cases (39.5%). In the 110 cases, 96 cases (87.3%) were abnormal indicated by cerebral atrophy mostly located in the anterior brain and abnormal signals distributed in various regions of the brain mostly in the frontal lobe and temporal lobe.
The symptoms of GPI were complex and easy to misdiagnose. The clinicians were still short of vigilance for neurosyphilis. We should expand serologic testing for syphilis especially in patients with cognitive impairment and neuropsychiatric symptoms. We suggest syphilis curricula in the training program of the clinicians especially for neurologist and psychiatrist.
我们旨在研究麻痹性痴呆（GPI）患者的临床表现、体液变化及神经影像学改变。
回顾性分析2010年至2020年在首都医科大学附属北京地坛医院收治的119例GPI患者。
119例GPI患者中，男性103例（86.6%）。误诊率高达83.2%，精神分裂症和心境障碍是最常见的误诊疾病。从症状出现到最终确诊的时间为10.4±12.9个月。主要临床表现包括认知障碍（114例，95.8%）和神经精神症状（107例，90.0%）。蒙特利尔认知评估量表（MoCA）评分显示的认知领域，包括延迟回忆、视觉空间/执行功能和语言能力，均受到严重损害。所有GPI患者的快速血浆反应素环状卡片试验（RPR）血清阳性率为100%，脑脊液（CSF）阳性率为89.9%。73例GPI患者（61.3%）的脑脊液白细胞（WBC）计数在6至50/μL之间。47例（39.5%）患者的蛋白水平在45.1至70mg/dL之间。110例患者中，96例（87.3%）存在脑萎缩，主要位于前脑，且大脑各区域出现异常信号，主要在额叶和颞叶。
GPI症状复杂，易误诊。临床医生对神经梅毒仍缺乏警惕性。我们应扩大梅毒血清学检测，尤其是对有认知障碍和神经精神症状的患者。我们建议在临床医生培训项目中纳入梅毒相关课程，尤其是针对神经科医生和精神科医生。
