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首页> 外文期刊>The Internet Journal of Neurology >Syphilitic Optic Neuropathy: Diagnosis Not To Be Missed
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Syphilitic Optic Neuropathy: Diagnosis Not To Be Missed

机译：梅毒性视神经病变：不容错过的诊断

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Purpose of the study: To describe two cases of syphilis presenting with optic neuropathy and to highlight the importance of considering syphilis in the evaluation of optic neuropathy. Method: Complete physical and ophthalmologic examination was performed in patients along with the necessary laboratory investigations including cerebrospinal fluid (CSF) analysis, syphilis serology in serum and CSF and HIV serology. Results: Both patients presented with unilateral optic perineuritis evident as swollen optic discs, normal visual acuity and normal pupillary reactions to light and accommodation. Complete recovery of optic neuropathy was achieved in both patients following treatment with procaine penicillin which was administered with oral probenecid and a short course of steroids. Conclusion: Early diagnosis and prompt treatment with penicillin is essential to prevent visual impairment in syphilitic optic neuropathy. Introduction The incidence of sexually transmitted diseases (STD) including syphilis has been rising in recent years [1, 2]. The ability of this illness to imitate different ocular disorders often results in misdiagnosis or delayed diagnosis. We report two cases of syphilis presenting with optic neuropathy. As it is not commonly encountered by clinicians, the most important aspect of diagnosing ocular syphilis is having a high index of clinical suspicion. Case History Case 1A 40 year old man presented to the eye clinic with intermittent painless visual blurring in his left eye for 2 weeks. Six months earlier, he had had a retinal detachment of his left eye and was concerned that he might be developing a recurrence. He denied other neurological or systemic symptoms. On examination visual acuity was 6/6 in both eyes with an enlarged blind spot in the left eye. Pupillary reactions and colour vision was normal in both eyes. Fundoscopy revealed a markedly swollen left optic disc (Figure 1.1). The right optic disc was normal. There were no signs of uveitis and retinal vasculitis. A working diagnosis of optic neuritis was made. He presented to the genitourinary medicine clinic several days later with a history of feeling tired for a few weeks following several unsafe sexual contacts. On direct questioning, he admitted to a history of skin rash on his torso and the inner aspects of his arms six months earlier which lasted for 4-6 weeks.On investigations, his full blood count and ESR were normal. Serum treponemal EIA and TPA serology was positive with a VDRL titre of 64. MRI of brain and orbit was normal. CSF examination showed 6 white cells/mm3; protein of 0.28g/L and glucose of 4mmol/L (serum glucose of 5.2 mmol/L). No organisms were seen in the CSF. CSF TPA and VDRL were positive thereby confirming the diagnosis of neurosyphilis. He was treated with intramuscular procaine penicillin 2.4 grams once daily and probenecid 500 mg 6 hourly for 17 days along with a short course of prednisolone. Following treatment, the left optic disc swelling had almost fully resolved six weeks later (Figure 1.2).
机译：研究目的：描述两例伴有视神经病变的梅毒病例，并强调在评估视神经病变时考虑梅毒的重要性。方法：对患者进行全面的身体和眼科检查，并进行必要的实验室检查，包括脑脊液（CSF）分析，血清梅毒血清学以及CSF和HIV血清学。结果：两名患者均表现为单侧视神经膜炎，表现为视盘肿胀，视力正常，瞳孔对光和调节的反应正常。普鲁卡因青霉素治疗后，口服丙磺舒和短暂类固醇激素治疗，均使视神经病变完全恢复。结论：青霉素的早期诊断和及时治疗对于预防梅毒性视神经病变的视力损害至关重要。简介近年来，包括梅毒在内的性传播疾病（STD）的发病率一直在上升[1，2]。这种疾病模仿不同眼病的能力通常会导致误诊或延迟诊断。我们报告了两例梅毒伴视神经病变的病例。由于临床医师通常不遇到这种情况，因此诊断眼梅毒的最重要方面是临床怀疑指数高。案例历史案例1一名40岁的男子出现在眼科诊所，其左眼间歇性无痛视物模糊了2周。六个月前，他的左眼视网膜脱离，担心他可能复发。他否认有其他神经或全身症状。检查时，两只眼睛的视力均为6/6，左眼盲点增大。双眼瞳孔反应和色觉正常。眼底镜检查发现左视盘明显肿胀（图1.1）。右视盘正常。没有葡萄膜炎和视网膜血管炎的迹象。进行了视神经炎的工作诊断。几天后，他出现在泌尿生殖医学诊所，因几次不安全的性接触而感到疲倦已有几周的历史。直接询问后，他承认六个月前持续了4-6周的躯干和手臂内部皮疹史，经调查，他的全血细胞计数和ESR正常。血清椎体EIA和TPA血清学均为阳性，VDRL滴度为64。脑和眼的MRI正常。脑脊液检查显示6个白细胞/ mm3;蛋白质为0.28g / L，葡萄糖为4mmol / L（血清葡萄糖为5.2mmol / L）。在脑脊液中未见任何生物。 CSF TPA和VDRL呈阳性，从而证实了神经梅毒的诊断。每天一次肌肉内注射普鲁卡因青霉素2.4克治疗他，每天6小时一次500毫克丙磺舒，持续17天，同时服用一小段泼尼松龙。治疗后，左视盘肿胀在六周后几乎完全消退（图1.2）。

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