Spinal syphilis
Introduction
Introduction to spinal syphilis Myelosyphilis is an important type of central nervous syphilis, including tabersdorsalis, spinal meningovascularsyphilis, and syphilitic myelitis. Syphilitic myelitis is often caused by lesions involving the meninges, also known as syphilitic meningeal myelitis, caused by a thin, spiral, active microbe, Treponema pallidum. Treponema pallidum often enters the central nervous system 3 to 18 months after infection. (syphiliticmeningomyelitis). basic knowledge The proportion of illness: 0.0003% Susceptible people: more common in men Mode of infection: non-infectious Complications: chronic heart failure, angina, cough
Cause
Cause of spinal cord syphilis
Spiral infection (30%):
Syphilis is caused by a slender, spiral, active microbe, Treponema pallidum, which often enters the central nervous system 3 to 18 months after infection. If the cerebrospinal fluid is completely examined after 2 years of infection. If it is negative, the chance of suffering from central syphilis is 1/20; if the cerebrospinal fluid examination is completely negative after 5 years of infection, the chance is reduced to 1/100.
Spinal cord hernia (30%):
The posterior root of the spinal cord, especially the posterior root of the lumbosacral section, became thinner and grayer. Due to the degeneration of the posterior column of the spinal cord, the spinal cord itself became thinner. Only a few neurons in the dorsal root ganglia were seen, and the peripheral nerves were basically normal. The central infection of syphilis begins with syphilitic meningitis (about 1/4 of total syphilis infection), a large part of which is asymptomatic meningitis, which can only be found through lumbar puncture.
Spinal cord vascular syphilis (30%):
Subacute or acute transverse spinal cord injury, endocarditis, perivascular inflammatory cell exudation and meningeal infiltration, and degeneration of myelin and axons in the spinal cord. Few of them are more severe meningitis with cranial nerve palsy, epilepsy, elevated intracranial pressure, etc., syphilitic meningitis can go through the asymptomatic phase for several years and eventually enter the brain or spinal cord, including the meninges. Vascular syphilis, paralytic dementia, spinal cord spasm, syphilitic meningeal myelitis.
The syphilis meningeal myelitis is inflamed and thickened by the dura mater, and adheres to the arachnoid and the soft meninges, which in turn causes damage to the spinal cord supplying blood vessels and nerve roots, resulting in spinal cord degeneration, and signs of long-term spinal cord injury.
Prevention
Spinal syphilis prevention
Since the liberation of our country, the government has banned prostitution and conducted census and prevention in some areas. By the end of the 1950s, the disease had been basically eliminated. In some countries in Europe and America, it was also due to early diagnosis and treatment and the application of penicillin and other drugs. The incidence of neurosyphilis has decreased significantly, especially the main syphilis has decreased significantly, but in the past 10 years, new syphilis patients in China, especially meningeal and vascular syphilis patients have increased, and some are accompanied by AIDS, which must be vigorously Promote medical health knowledge, strengthen cultural quality education, and make people understand the harmfulness of sexually transmitted diseases, even if they are controlled from certain systems, in order to prevent and control the occurrence of this disease from the source.
Complication
Spinal syphilis complications Complications chronic heart failure angina pep
Syphilitic heart disease often occurs 10 to 20 years after suffering from syphilis, mainly invading the aorta, initially showing aortic inflammation, then aortic enlargement, aortic valve damage and aortic regurgitation; can also lead to coronary ostia Narrowing, there is no clinical symptoms in the early stage of the clinic, and there may be cardiac dysfunction, angina pectoris, cough, and hoarseness in the advanced stage.
Symptom
Symptoms of syphilis in the spinal cord Common symptoms Lightning-like pain reflexes disappeared Knee, tendon reflexes, closed eyes, difficult to sign, dysuria, urinary retention, abdominal pain, lower limb vibration and position... Nausea and vomiting, difficulty breathing, urination pain
Spinal cord fistula
It usually occurs 15 to 20 years after syphilis infection. Males are more common. The main symptoms are lightning-like pain, sensory ataxia and urinary incontinence. The main signs are knee reflex and tendon reflex, and lower limb vibration and positional impairment. Closed eyes are difficult to sign positive.
(1) Ocular manifestations: More than 90% of patients have pupillary abnormalities, usually manifested as A-Luo pupil, that is, the bilateral pupils are not large, narrow, and irregular, and the light reflection disappears, but the adjustment reflection exists, most of them are accompanied. Cocoon and varying degrees of ophthalmoplegia, optic atrophy are also common.
(2) Sensory disturbance: more than 90% of patients have lightning-like pain, more common in the lower limbs, but they can also pain from the face to the lower limbs. The pain is sharp and short-lived. The nature is lightning-like, knife-like, tear-like, burning. Etc. Occasionally, pain can be sustained in a certain place. The ataxia is caused by a deep sensory disorder. The gait is squatting when walking. It is a cross-threshold gait (the lower limbs are excessively raised when walking, and the stepping is more forceful, each step size Not a), even in the late stage, even if the muscle strength is intact, it is difficult to walk.
(3) sphincter dysfunction: due to the posterior root lesion of the waist 2 to 4 segments, affecting the bladder sensation, although the bladder is full and no urine, forming urinary retention and filling urinary incontinence.
(4) visceral crisis: gastric crisis is the most common, manifested as sudden upper abdominal pain, and can extend to the chest, chest has a sense of contraction, may be associated with nausea, vomiting, vomiting often repeated to spit bile, after the attack, patients often Exhausted and feeling aching on the upper abdomen, colic and diarrhea in the small intestine crisis; swallowing movements and dyspnea during pharyngeal and laryngeal crisis; urgency and weight in rectal crisis; urination pain in genitourinary tract crisis And difficulties, except for the stomach crisis, other crises are rare.
(5) Spinal ankle joint disease (Charcot arthritis): Charcot arthritis occurs in about 1/10 patients with spinal cord spasm, mainly involving the hip, knee and ankle joints. It can also affect the lumbar spine and upper limbs. It is initially osteoarthritis. Injury, joint surface destruction, loss of bone structural integrity, and fracture and dislocation, Charcot arthritis is not parallel to the activity of central syphilis.
(6) Most patients maintain good muscle strength.
2. syphilitic meningeal myelitis and spinal cord vascular syphilis
Often 3 to 5 years after the onset of syphilis infection, syphilis meningitis due to its clinical manifestations of bilateral corticospinal tract damage, also known as Erb's spastic paraplegia (Erb's spastic paraplegia; part of the main involvement of the meninges Often, due to thickening of the meninges, adhesions, compression of nerve roots and spinal cord, manifested as neck, shoulder, upper limb root pain, muscle atrophy and lower limbs (syphilitic amyotrophy with spastic-ataxic paraparesis), meningeal blood vessels of the spinal cord Sexual syphilis is mainly caused by vascular involvement. Spinal vascular thrombosis often occurs due to endarteritis. The onset is rapid, and the symptoms depend on the extent of the affected blood vessels. Occasionally, the anterior vertebral artery syndrome caused by the anterior vertebral artery thrombosis, deep feeling Can be kept intact.
Examine
Spinal syphilis examination
Cerebrospinal fluid examination
It is a sensitive indicator of neurosyphilis activity. Patients with neurosyphilis often show abnormalities, and the number of cells increases. (200-300)×106/L, mostly lymphocytes and a small number of plasma cells and monocytes, the protein of cerebrospinal fluid is elevated, 0.4 ~ 2g / L, cerebrospinal fluid IgG increased, sugar is generally normal.
2. Serological tests of syphilis
Including non-specific veterinary disease research laboratory (VDRL) flocculation test and specific treponemal antibody absorption (FTA-ABS) and treponemal pallidum immobilization (TPI) ).
VDRL has a higher proportion of false negatives. It can be negative in advanced syphilis and some special syphilis (also known as seronegative syphilis), and the positive rate of FTA-ABS and TPI is high, which is more reliable with TPI, but relative to FTA-ABS. Said that the trial cost is more expensive, there is no FTA-ABS to get used, cerebrospinal fluid VDRL and FTA-ABS positive has diagnostic significance.
3. Blood routine, blood biochemistry, electrolytes, blood sugar, immune project examination, have differential diagnosis significance.
Imaging examination of neurosyphilis CT, MRI examination can show single or several small low-density infarcts in the diseased tissue.
Diagnosis
Diagnosis and differentiation of spinal syphilis
According to the history of smelting, the history of syphilis infection, spinal cord damage, typical A-Luo pupil, positive for VDRL and FTA-ABS in serum and cerebrospinal fluid, the diagnosis is not difficult.
However, it still needs to be differentiated from other diseases. Syphilis meningeal myelitis needs to be differentiated from motor neuron disease, cervical spondylosis, multiple sclerosis, spinal cord tumor, etc.; spinal cord spasm needs to be differentiated from diabetes, subacute combined degeneration, pseudo spinal cord paralysis .
