神经梅毒误诊为急性脑梗死患者临床分析及经验总结OA

Objective To analyze the clinical data of neurosyphilis misdiagnosed as acute cerebral infarction(ACI),to investigate the causes of the misdiagnosis,and to summarize the preventive measures,so as to reduce the misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of a patient with neurosyphilis initially misdiagnosed as ACI who were admitted in October 2024.Results A 70-year-old male patient was admitted to the hospital due to"slow response for 2 years,and unclear speech and abnormal behavior for 5 h.The manifestations were slurred speech and abnormal psychiatric and behavioral symptoms.Based on the early results of head magnetic resonance imaging(MRI)examination,he was diagnosed with ACI and received symptomatic treatment,but the effect was not satisfactory.After consultation and careful review of the head MRI scans upon admission,the findings did not conform to the cerebrovascular distribution pattern characteristic of cerebrovascular disease.Upon further investigation into the patient's history of unexplained slow response onset two years prior,along with the development of fever after admission and observed pupillary changes during physical examination,a screening for serum Treponema pallidum antibodies was conducted and returned positive,and results of subsequent lumbar puncture for cerebrospinal fluid analysis indicated positive treponemal antibody(titer 1∶8).Finally,he was diagnosed with neurosyphilis,and the misdiagnosis period was 20 d.After standard anti-syphilitic treatment,his slurred speech and abnormal psychiatric and behavioral symptoms improved,but cognitive dysfunction,including memory decline and slow response,persisted.At 1-year follow-up,his condition remained stable.Conclusion The clinical manifestations of neurosyphilis are complex and diverse,lacking specific features.Solely based on the patient's medical history,symptoms and signs,it is difficult to make an early diagnosis of neurosyphilis.Clinicians should continuously enhance their understanding of this disease and their ability to make differential diagnoses.When stuck in a diagnostic dilemma,they should promptly conduct targeted imaging examinations,serum Treponema pallidum antibody testing or lumbar puncture for cerebrospinal fluid tests to reduce misdiagnosis.Once a patient is diagnosed,they should receive early,standardized and systematic syphilis treatment,which is of great significance for improving patient prognosis.