Zifko U, Schmidt B, Grisold W, Stanek G
Neurologischen Abteilung, Kaiser-Franz-Josef-Spitals, Wien.
Wien Med Wochenschr. 1995;145(7-8):191-4.
A 35-year old man was presented with organic psychosyndrome. Anamnestic reports informed about changes in his behaviour like loss of interest, reduced concentration and short-term-memory loss within the last 2 years. The practicing psychiatrist diagnosed a depressive syndrome in conjunction with a borderline syndrome and administered antidepressive and neuroleptic therapy. Specific serologic tests were not done. Neurologically, there was a picture of influent and slurred speech, and ataxic gait. Muscle tonus was normal, muscle reflexes were of the same diminished intensity on both sides. The psychic status revealed a person mostly oriented in time, location and situation but with severe disorders of recognition, concentration, and memory. Laboratory diagnosis proved the suspected diagnosis of neurosyphilis. Additionally, there were antibodies to Borrelia burgdorferi (Bb) in serum and CSF and a positive CSF/serum index of 9.0 (threshold: 1.9). The neuroradiologic examination (CCT, NMR, SPECT) showed an intense, diffuse, frontotemporal atrophy of the cortex. By NMR, massive gliosis was found in both hippocampi. Angiographically, an aneurysma (1 cm in diameter) of the medial cerebral artery was demonstrated. Specific treatment was performed with Na penicillin (5 Mio. i.v./4 h over 21 days). No remission could be achieved.
一名35岁男性患有器质性精神综合征。既往史报告显示，在过去2年里他的行为出现了变化，如兴趣丧失、注意力不集中和短期记忆丧失。执业精神科医生诊断为抑郁综合征合并边缘性综合征，并给予抗抑郁和抗精神病药物治疗。未进行特定的血清学检查。神经系统检查发现患者存在言语流利性和清晰度下降以及共济失调步态。肌肉张力正常，双侧肌肉反射强度均减弱。精神状态检查显示患者在时间、地点和人物定向方面基本正常，但存在严重的认知、注意力和记忆障碍。实验室诊断证实了疑似神经梅毒的诊断。此外，血清和脑脊液中存在抗伯氏疏螺旋体（Bb）抗体，脑脊液/血清指数为9.0（阈值：1.9）。神经放射学检查（计算机断层扫描、核磁共振成像、单光子发射计算机断层扫描）显示大脑皮层有严重的弥漫性额颞叶萎缩。核磁共振成像显示双侧海马有大量胶质增生。血管造影显示大脑中动脉有一个动脉瘤（直径1厘米）。采用青霉素钠（500万单位静脉注射，每4小时一次，共21天）进行了特异性治疗，但未实现病情缓解。
