Vertigo and sensorineural hearing loss due to syphilis: differential diagnosis and treatment
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摘要: 目的：分析反复发作的难治性眩晕以及临床表现不符合已知疾病谱的感音神经性聋的可能病因，探讨预防漏诊或误诊的筛查方法，拓宽少见病因的诊疗思路。方法：回顾性分析梅毒血清学阳性的4例眩晕症患者以及2例听力损失患者的临床表现、诊疗经过及预后。6例均采用大剂量水剂青霉素治疗（2 400万U/d），分次给药，疗程14 d。结果：梅毒感染者的眩晕及听力损失等临床表现、听功能、前庭功能及影像诊断缺乏特异性。经规范的驱梅治疗，5例临床症状改善满意，1例低频感音神经性聋患者听力仍然反复波动。结论：梅毒感染后可通过颞骨骨炎、内淋巴囊周围纤维化导致迷路积水或神经梅毒侵犯第Ⅷ脑神经而导致眩晕及听力损失。对于反复发作的难治性眩晕及临床表现不符合已知疾病谱的单耳或双耳快速进行性感音神经性聋，建议做梅毒血清学筛查及验证以防漏诊或误诊。
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关键词:
- 耳梅毒 /
- 神经梅毒 /
- 眩晕 /
- 听力损失,感音神经性 /
- 诊断,鉴别
Abstract: Objective: To analyze the etiology of repeatedly attacks of intractable vertigo and some types of sensorineural deafness whose clinical manifestation were not in conformity with the known spectrum diseases,and explore the screening method to prevent missed diagnosis or misdiagnosis,then provide references for clinical diagnosis and treatment for rare etiology.Method: The authors retrospectively analyzed the clinical manifestations, diagnosis, treatment and prognosis from 4 cases of vertigo sufferers and 2 cases of hearing impairment sufferers whose serological tests were positive for syphilis. All these 6 cases were treated with large doses of penicillin aqueous solutions(24 million U/d), multi-times intravenous infusion, the course of the treatment was 14 d.Result: The clinical manifestations of these 6 patients were lack of characteristic, as well as the results of hearing and vestibular function, imaging diagnosis.Positive syphilis detection of serology and cerebrospinal fluid tests were the main diagnostic basis. After anti-syphilis treatment, 5 cases got satisfied clinical symptoms improvement, 1 case suffered from low-tone sensorineural hearing loss, whose hearing fluctuated recurrently.Conclusion: Syphilis infection may damage the Ⅷ cranial nerve and then lead to vertigo and hearing loss, through chronic syphilitic osteitis of temporal bone, atrophy of organ of corti, osteolytic lesion surrounding the endolymphatic duct, and neurosyphilis. For patients presented with intractable vertigo, and those whose clinical manifestations are not in conformity with the known diseases of unilateral ear or bilateral ears rapidly progressive deafness, syphilis serology screening and validation tests are recommended in case of missed diagnosis or misdiagnosis.-
Key words:
- otosyphilis /
- neurosyphilis /
- vertigo /
- hearing loss, sensorineural /
- diagnosis,differential
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