頭蓋内出血で発症した神経梅毒の1症例

Intracranial Hemorrhage Caused by Neurosyphilis: A Case Report

Ⅰ．はじめに

　梅毒はTreponema pallidumの感染による代表的な性感染症で，慢性の全身性の感染症である．1940年代にペニシリンが開発されたことにより，梅毒の発生率は急激に減少した．しかし，近年，ヒト免疫不全ウイルス（HIV）と梅毒の合併症例が増加しており，再び注目されている疾患である^1,5,10)．脳卒中の原因となる神経梅毒の病型としては髄膜血管型が挙げられるが，一過性脳虚血発作（TIA）や脳梗塞といった虚血症状として発症することがほとんどである¹⁾．今回，われわれは梅毒感染が原因と考えられた頭蓋内出血の稀な1例を経験したので報告する．

　It is well known that neurosyphilis is a cause of stroke and its main subtype is ischemic stroke. In this report, we present a rare case with intracranial hemorrhage in left frontal lobe and subarachnoid hemorrhage due to neurosyphilis. A 56-year-old man developed conscious disturbance, right hemiparesis, and motor aphasia, and was admitted to our hospital. Rapid plasma reagin（RPR）and fluorescent treponemal antibody-absorption（FTA-ABS）serology was positive in blood and cerebrospinal fluid. MR angiography and 3D-CT angiography demonstrated no vascular abnormalities. He responded well to penicillin treatment, followed by complete resolution of his neurological symptoms. Diagnosis of neurosyphilis is sometimes difficult, as patients usually present with non-specific symptoms such as intracranial hemorrhage. To our knowledge, only 3 cases of intracranial hemorrhage caused by neurosyphilis have been reported previously. This case is reported to raise the awareness of this uncommon but important manifestation of neurosyphilis.