Liu Jun, Zhang Wenjun, Jiang Qiuhua, Huang Qianliang, Ye Xinyun
Department of Neurosurgery, The 2nd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Department of Neurosurgery, The Ganzhou Affiliated Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, China.
Front Med (Lausanne). 2024 Nov 27;11:1448698. doi: 10.3389/fmed.2024.1448698. eCollection 2024.
Cerebral syphilitic gumma (CSG), a rare manifestation of neurosyphilis, presents characteristics akin to intracranial tumors, often leading to clinical misdiagnosis.
This study aimed to summarize the clinical experience in diagnosing and treating CSG.
The present study conducted a retrospective analysis of clinical data, encompassing the baseline characteristics, clinical presentation, diagnosis, treatment, and prognosis of eight patients with CSG who were treated and diagnosed by our institution.
The median age at the initial diagnosis was 57.5 years, comprising six males and two females. The predominant clinical manifestations included headaches in eight cases, motor and sensory disorders in four cases, epileptic seizures in one case, and dysarthria in one patient. The serum haemagglutination assay (TPHA) and toluidine red unheated serum test (TRUST) yielded positive in all eight patients. The contrast-enhanced magnetic resonance imaging (MRI) revealed irregular ring-shaped enhancement of lesions in three patients, while nodular enhancement of lesions was observed in five patients. In terms of treatment, seven patients underwent surgery. The postoperative pathological tissue showed granulomatous inflammation. Six patients exhibited an elevated protein concentration in their cerebrospinal fluid (CSF), while two patients demonstrated a reduced CSF glucose level. Additionally, positive results were obtained for both CSF TPHA and TRUST in all eight patients. The clinical diagnosis of CSG was confirmed in eight patients who exhibited notable clinical improvement following penicillin treatment. Subsequent reevaluation of the imaging findings demonstrated complete resolution of the enhanced lesions.
In clinical practice, CSG should be considered for patients with intracranial lesions and positive serum syphilis antibodies. Timely and accurate diagnosis enables patients with CSG to achieve a more favorable prognosis through active anti-syphilis treatment.
脑梅毒瘤（CSG）是神经梅毒的一种罕见表现，具有类似于颅内肿瘤的特征，常导致临床误诊。
本研究旨在总结脑梅毒瘤的诊断和治疗经验。
本研究对我院诊治的8例脑梅毒瘤患者的临床资料进行回顾性分析，内容包括基线特征、临床表现、诊断、治疗及预后。
初次诊断时的中位年龄为57.5岁，其中男性6例，女性2例。主要临床表现包括8例头痛、4例运动和感觉障碍、1例癫痫发作、1例构音障碍。8例患者的血清血凝试验（TPHA）和甲苯胺红不加热血清试验（TRUST）均呈阳性。对比增强磁共振成像（MRI）显示3例患者病变呈不规则环形强化，5例患者病变呈结节状强化。治疗方面，7例患者接受了手术。术后病理组织显示为肉芽肿性炎症。6例患者脑脊液（CSF）蛋白浓度升高，2例患者脑脊液葡萄糖水平降低。此外，8例患者的脑脊液TPHA和TRUST均呈阳性。8例患者经青霉素治疗后临床症状明显改善，确诊为脑梅毒瘤。随后对影像学检查结果的重新评估显示强化病变完全消退。
在临床实践中，对于颅内病变且血清梅毒抗体阳性的患者应考虑脑梅毒瘤。及时准确的诊断可使脑梅毒瘤患者通过积极的抗梅毒治疗获得更良好的预后。
