麻痹性痴呆一例报告

患者男性,47岁,2006年8月17日入院.2月前出现记忆减退,性格改变,原内向性格变为言语多,且自言自语,爱管闲事,行为异常,经常捡些垃圾回家.     

麻痹性痴呆的临床特征与诊断(附2例报告)

目的探讨麻痹性痴呆的临床特征,以及实验室及影像学检查在诊断中的价值。方法回顾性分析2例麻痹性痴呆患者的临床资料,并结合文献进行讨论。结果主要临床表现为隐匿起病,进行性加重性痴呆、精神障碍、癫痫发作等;2例患者均被误诊。血清及脑脊液快速血浆反应素环状卡片试验（RPR）阳性,梅毒螺旋体明胶凝集试验（TPPA）阳性,头颅MRI主要表现为弥漫性脑萎缩。结论麻痹性痴呆的临床表现复杂多变,早期误诊率高;诊断主要根据临床特点、血清学及脑脊液检查综合考虑。     

麻痹性痴呆

近年来随着梅毒的发病率的升高 ,神经梅毒的发病亦有增加 ,麻痹性痴呆作为其最严重的一种类型应该引起足够重视。麻痹性痴呆因是一种可治的痴呆 ,及早诊断 ,对其预后有积极的意义。     

麻痹性痴呆2例报告

近10年随着性病在我国再度蔓延，以往罕见的神经梅毒时有出现，现就我院近期收治的2例麻痹性痴呆报告如下。     

麻痹性痴呆96例临床分析

目的提高对麻痹性痴呆临床特征的认识,避免误诊。方法回顾性分析96例麻痹性痴呆患者的临床资料、相关检查、治疗及预后。结果患者表现不同程度的痴呆、精神病样症状及多种神经系统损害的症状和体征;头颅MRI有特征性改变;血液和脑脊液RPR和TPPA均阳性;大剂量青霉素治疗有效。结论麻痹性痴呆临床表现多种多样,容易误诊,需临床医师提高警惕。     

麻痹性痴呆12例临床分析

目的探讨麻痹性痴呆(GPI)患者的临床表现,实验室检查、影像学、脑电图特征以及诊断、治疗及预后。方法回顾性分析经临床和实验室确诊的12例GPI患者的相关资料。结果GPI患者临床以智能障碍、精神异常、癫痫最常见。12例患者血清甲苯胺红凝集试验(TRUST)和梅毒螺旋体明胶凝集试验(TPPA)均( ),脑脊液TPPA均( ),而TRUST( )9例。头颅MRI检查结果示大脑皮质萎缩。3例以肢体抽搐为表现者脑电图可见广泛中高幅尖慢波,余脑电图为弥漫性慢波。经抗梅毒治疗,痊愈4例,显效5例,好转3例。结论GPI现已是我国神经梅毒分型中极常见类型,多见于中年男性,临床表现多变,早期误诊率高,早期发现、及时正规治疗预后好。     

麻痹性痴呆1例

患者,女性,50岁,近6个月来无明显诱因出现言语减少,胃纳不佳,活动减少,在区精神卫生中心就诊,诊断为“抑郁症”。予以路滴美75mg／d治疗,病情有所改善后自行停药,遂出现行为异常,丢三拉四,言语零乱,夜眠差,头晕、心慌,予以奥麦伦治疗,疗效欠佳,为进一步治疗住入我院。个人史：两年前因丈夫有外遇离异,离婚后无不洁性交史。既往史、家族史无特殊。     

麻痹性痴呆1例

1病例患者,男,48岁,大学文化,已婚。因乱语,记忆力下降2年,加重2个月,于2005年9月14日住本院。患者于1999年在单位出现重大差错而辞职回家,逐渐出现记忆力下降,自觉脸变胖、发麻,易激惹,讲一些莫名其妙的话。2个月前出现自语,说有小人附在自己身上,外出不认识回家的路。否认冶游史。体检面具样脸,走路姿势僵硬,余未见明显阳性体征。精神检查:接触差,呆滞,答不切题,重复言语,反复讲“北京艾滋病”;理解能力差,不能理解“坐井观天”等成语的意思;不能计算100连续减7;注意力不集中,有空间感知觉综合障碍。实验室检查:血常规、肝功能正常;血清梅…     

麻痹性痴呆的临床及影像特点

目的:分析麻痹性痴呆(GPI)的临床及影像特征及提供早期诊断依据。方法:回顾性分析经临床及实验室确诊的1例麻痹性痴呆患者的有关临床资料。结果:麻痹性痴呆早期以认知及精神症状为主要表现,影像上主要为脑室扩大,实验室检查有特征性改变。结论:麻痹性痴呆早期临床容易误诊,应重视梅毒血清和脑脊液抗体的检查,结合CT、 MRI可以诊断,大剂量足疗程青霉素治疗能取得显著疗效。     

麻痹性痴呆8例临床分析

麻痹性痴呆（general paresis of insane,GPI）是神经梅毒的一种类型,是梅毒螺旋体侵犯中枢神经系统实质而导致的神经精神功能障碍,近年来发病率有逐年增高的趋势.现将我院2000年1月～2006年2月共收治的8例GPI进行分并讨论其临床特点及诊断。[第一段]     

Friedrich Nietzsche's mental illness--general paralysis of the insane vs. frontotemporal dementia

OBJECTIVE: For a long time it was thought that Nietzsche suffered from general paralysis of the insane (GPI). However, this diagnosis has been questioned recently, and alternative diagnoses have been proposed. METHOD: We have charted Friedrich Nietzsche's final fatal illness, and viewed the differential diagnosis in the light of recent neurological understandings of dementia syndromes. RESULTS: It is unclear that Nietzsche ever had syphilis. He lacked progressive motor and other neurological features of a progressive syphilitic central nervous system (CNS) infection and lived at least 12 years following the onset of his CNS signs, which would be extremely rare for patients with untreated GPI. Finally, his flourish of productivity in 1888 would be quite uncharacteristic of GPI, but in keeping with reports of burgeoning creativity at some point in the progression of frontotemporal dementia (FTD). CONCLUSION: We suggest that Nietzsche did not have GPI, but died from a chronic dementia, namely FTD.     

麻痹性痴呆12例误诊原因分析

目的：分析麻痹性痴呆（GPI）误诊原因。方法：回顾性分析12例麻痹性痴呆患者的临床资料,智能检测和各项实验室检查结果。结果：12例患者曾误诊为精神分裂症4例,躁狂发作3例,老年性痴呆3例,多发性硬化和病毒性脑炎各1例。所有患者梅毒螺旋体血液检查及脑脊液检查均为阳性,简易智力状态量表评分均≤20分。经大剂量青霉素治疗后,一般精神症状控制,智力部分恢复,神经体征残留。结论：麻痹性痴呆极易被误诊,忽略了患者的认知障碍和未做细致的神经系统检查是误诊的重要原因。早期诊断和治疗是预后的关键。     

不同时期麻痹性痴呆临床对照研究

目的：分析1947年至1966年和2004年至2007年丽个不同历史时期麻痹性痴呆（GPI）患者的临床差异。方法：回顾性调查1947年6月至2007年6月GPI住院患者临床情况。病例分旧患者组（1947年至1966年时期247例中随机抽取50例）,和新患者组（2004年至2007年期间,计12例）两组,进行对照分析。结果：旧患者组收治12．4例／年,新患者组3．42例／年;入院前和入院3d内作血液和脑脊液梅毒抗体检测旧患者组96％,新患者组为0％;临床误诊率旧患者组4％,新患者组100％;两组差异有显著性（P〈0．01）。结论：目前GPI临床少见,患者性病冶游史隐蔽,临床血清梅毒的筛查未列为常规性检查,容易导致误诊。     

Neurosyphilis presenting as mania

Barbosa IG, Vale TC, de Macedo DL, Gomez RS, Teixeira AL. Neurosyphilis presenting as mania. Bipolar Disord 2012: 14: 309–312. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: General paresis of the insane is a late and severe form of neurosyphilis characterized by nonspecific neuropsychiatric symptoms. There are a limited number of case reports of mood disorders presenting in neurosyphilis, with depressive illness being the most common. Methods: We performed a literature review of case reports of secondary bipolar disorder induced by syphilitic infection. Results: Herein reported is a case of a 53‐year‐old woman who initially presented with symptoms of mania and depression, mimicking bipolar disorder, but was subsequently diagnosed with general paresis of the insane. Conclusion: The present case report emphasizes that if a substantial delay occurs in syphilis diagnosis and management, the patient may have a very poor prognosis.     

General paralysis of the insane and AIDS in old age psychiatry: epidemiology,clinical diagnosis,serology and ethics—the way forward

While the incidence of general paralysis of the insane (GPI) has declined, AIDS (acquired immune deficiency syndrome) has emerged as a new illness. Today, in England and Wales, as many elderly people die from AIDS as from neurosyphilis, although both diagnoses are rare in this age group. Both are serious medical conditions with psychiatric manifestations. For both, serological tests may identify the disease, and treatment may be of benefit, but there is considerable social stigma attached to the diagnoses. Ethical guidelines for serological testing for HIV (human immunodeficiency virus) have been available for over a decade. In view of the similarities between the diseases, it may be unethical to test patients for syphilis routinely. Epidemiology, risk factors, neurological and neuropsychiatric features and ethics must be considered before testing for both syphilis and HIV. Copyright © 1998 John Wiley & Sons, Ltd.     

麻痹性痴呆的MRI表现(附32例报道)

目的 探讨麻痹性痴呆(GPI)的MRI特征和诊断价值,提高对GPI患者MRI表现的认识.方法 中山大学第三附属医院放射科自2006年5月至2010年11月共诊断GPI患者32例,回顾性分析患者的临床资料并总结GPI的MRI表现.结果 本组患者的MRI表现分为两型:脑萎缩型(30例)和脑肿胀型(2例),其中脑萎缩型GPI的MRI表现为:(1)以颞叶、额叶、海马、胼胝体萎缩为主,脑白质萎缩较脑皮质萎缩明显;(2)杏仁体及海马形态异常及伴T2信号增高;(3)皮层/皮层下"脑回状"T2信号增高,以岛叶多见;(4)双侧豆状核对称性T2信号减低;脑肿胀型GPI的MRI表现为弥漫型或局灶型.结论 GPI的MRI表现多样,但具有一定特征性,结合临床表现和相关实验室检查结果可作出正确诊断.

Abstract：

Objective To evaluate the MRI findings in patients with general paresis of insane (GPI) to enhance the understanding of MRI diagnosis of this disease. Methods The clinical data and MRI findings of 32 patients with GPI, admitted to our hospital from May 2006 to November 2010, were retrospectively analyzed. Results The MRI findings of GPI were mainly divided into 2 types: cerebral atrophy (n=30) and cerebral swell (n=2). The major MRI findings in the type of cerebral atrophy included white cerebral atrophy in the temporal lobe, the frontal lobe, the hippocampus and the corpus callosum, morphological changes and T2 hyperintensity in the amygdaloid body and the hippocampus, gyral T2 hyperintensity in the cortex and subcortex, and T2 hypointensity in the lenticular nucleus. The MRI findings in the type of cerebral swell manifested as suffused and focal types. Conclusion The MRI findings in GPI are multiple with some characteristic manifestations. Diagnosis must be made through the combination of imaging features with clinical data and related laboratory tests.