Soeda Shin, Onoue Hiroyuki, Shinmura Yawara, Ebihara Satoshi, Suzuki Tone, Akaiwa Yasuhisa, Miyamoto Tomoyuki
Department of Neurology, Dokkyo Medical University Saitama Medical Center.
Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center.
Rinsho Shinkeigaku. 2022 Nov 26;62(11):873-876. doi: 10.5692/clinicalneurol.cn-001784. Epub 2022 Oct 26.
The patient was a 32-year-old man with no HIV infection and possible syphilis infection at the age of 22 years. At the age of 29 years, he visited an ophthalmologist for diplopia due to right oculomotor nerve palsy. He underwent diplopia strabismus surgery for unexplained oculomotor nerve palsy. At the age of 31 years, he had a left oculomotor nerve palsy and was referred to our department. He was diagnosed with neurosyphilis based on positive serum and cerebrospinal fluid syphilis antibodies. MRI showed aneurysm, asymptomatic cerebral hemorrhage, and contrast enhancement of the left oculomotor nerve, leading to the diagnosis of meningovascular syphilis. The patient's symptoms improved with penicillin and corticosteroids. The oculomotor nerve palsy may be due to microcirculatory disorder caused by syphilitic cerebral endarteritis.
该患者为一名32岁男性，无HIV感染，22岁时可能感染梅毒。29岁时，因右侧动眼神经麻痹导致复视而就诊于眼科医生。他因不明原因的动眼神经麻痹接受了复视斜视手术。31岁时，他出现左侧动眼神经麻痹，并被转诊至我科。根据血清和脑脊液梅毒抗体阳性，他被诊断为神经梅毒。MRI显示有动脉瘤、无症状性脑出血以及左侧动眼神经强化，从而诊断为脑膜血管梅毒。患者的症状通过青霉素和皮质类固醇治疗后有所改善。动眼神经麻痹可能是由梅毒性脑动脉内膜炎引起的微循环障碍所致。
