Giménez-Roldán S, Benito C, Martin M
J Neurol Neurosurg Psychiatry. 1979 Jun;42(6):501-8. doi: 10.1136/jnnp.42.6.501.
Five patients suffering from dementia paralytica who failed to improve or deteriorated after one or several high dosage courses of penicillin, had pneumoencephalographic patterns suggesting communicating hydrocephalus. Measurements of the ventricular index, ratio of cella media to width of the temporal horn, and the callosal angle differed from that in seven cases of dementia paralytica with associated cerebral atrophy. An isotope cisternogram in three cases with communicating hydrocephalus further confirmed a blockage of the cerebrospinal fluid (CSF) at the parasagittal subarachnoid space. Three patients exhibited the full syndrome of gait apraxia, incontinence, and pyramidal tract signs associated with a severe degree of dementia. Shunting of the CSF in three cases was followed by immediate improvement in two, one in a longlasting way. No active parenchymal inflammation was observed in any of three brain biopsy samples taken during surgery, except for leptomeningeal fibrosis in one. Chronic leptomeningitis in dementia paralytica may impair subarachnoid CSF absorption with subsequent communicating hydrocephalus. Progression or inadequate responses after therapeutic dose of penicillin in dementia paralytica should prompt investigation for this complication as an alternative, effective treatment could be offered.
5例麻痹性痴呆患者在接受一个或多个高剂量青霉素疗程后病情未改善或恶化，其气脑造影表现提示交通性脑积水。脑室指数、中脑导水管与颞角宽度之比以及胼胝体角的测量结果与7例伴有脑萎缩的麻痹性痴呆患者不同。3例交通性脑积水患者的同位素脑池造影进一步证实脑脊液（CSF）在矢状窦旁蛛网膜下腔受阻。3例患者表现出与严重痴呆相关的步态失用、尿失禁和锥体束征的完整综合征。3例患者进行脑脊液分流术后，2例立即改善，1例长期改善。手术中采集的3份脑活检样本中均未观察到活动性实质炎症，仅1例有软脑膜纤维化。麻痹性痴呆中的慢性软脑膜炎可能会损害蛛网膜下腔脑脊液的吸收，继而导致交通性脑积水。麻痹性痴呆患者在接受治疗剂量的青霉素后病情进展或反应不佳时，应考虑排查这一并发症，因为可以提供替代的有效治疗方法。
