Cheng Huanhuan, Zhu Haocheng, Shen Gang, Cheng Yaqi, Gong Jiao, Deng Juan
Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Neurol. 2024 Nov 28;15:1472274. doi: 10.3389/fneur.2024.1472274. eCollection 2024.
This study aimed to investigate ocular manifestations in patients with neurosyphilis and their association with general indexes.
This retrospective study was conducted among patients who were hospitalized for neurosyphilis from 2012 to 2022. Clinical manifestations, laboratory tests, brain MRI, and ocular examinations were reviewed and analyzed.
A total of 106 neurosyphilis patients were included, of which 10 patients presented with ocular signs as their initial symptoms. The most common main complaint was reduced vision (6/10), followed by diplopia (2/10) and ptosis (2/10). The causes of vision loss included optic neuropathy (4/6) and posterior uveitis (2/6), with all six patients showing optic nerve involvement. A total of 29 (27.4%) patients exhibited pupil abnormalities. A lumbar puncture was performed on all 106 patients, and abnormal cerebrospinal fluid (CSF) findings were revealed in 101 (95.3%) patients, indicating central nervous involvement. The median white blood cell count in the CSF of the patients with pupil abnormalities was significantly higher than that of those without pupil abnormalities (14.0 vs. 6.0 cells/μl, = 0.037). In addition, the patients with abnormal pupillary light reflex (PLR) were more likely to have multiple brain lesions compared to those with normal PLR (77.3% vs. 29.2%, < 0.001).
Optic nerve involvement is the main cause of vision loss in neurosyphilis. Patients with optic neuropathy or posterior uveitis should undergo prompt diagnostic evaluation for syphilis. Pupil abnormalities can serve as indicators of more severe CSF and MRI findings.
本研究旨在调查神经梅毒患者的眼部表现及其与一般指标的关联。
本回顾性研究纳入了2012年至2022年因神经梅毒住院的患者。对临床表现、实验室检查、脑部磁共振成像（MRI）和眼部检查进行了回顾与分析。
共纳入106例神经梅毒患者，其中10例以眼部体征为首发症状。最常见的主要症状是视力下降（6/10），其次是复视（2/10）和上睑下垂（2/10）。视力丧失的原因包括视神经病变（4/6）和后葡萄膜炎（2/6），所有6例患者均显示视神经受累。共有29例（27.4%）患者出现瞳孔异常。对所有106例患者进行了腰椎穿刺，101例（95.3%）患者脑脊液（CSF）检查结果异常，提示中枢神经系统受累。瞳孔异常患者脑脊液中的白细胞计数中位数显著高于无瞳孔异常患者（14.0对6.0个/μl，P = 0.037）。此外，与瞳孔对光反射（PLR）正常的患者相比，PLR异常的患者更易出现多发脑病变（77.3%对29.2%，P < 0.001）。
视神经受累是神经梅毒患者视力丧失的主要原因。患有视神经病变或后葡萄膜炎的患者应及时接受梅毒的诊断评估。瞳孔异常可作为脑脊液和MRI更严重表现的指标。
