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Yıl:2005; Cilt: 8; Sayı: 2>> Özet
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Klinik Psikiyatri Dergisi; 2005;8(2):100-104
Farklı Klinik Görünümlerle Başvuran İki Nörosifilis Olgusu
A Tiryaki, G Kandemir, E Aktepe, İ Ak
Karadeniz Teknik Üniversitesi Tıp Fakültesi Farabi Hastanesi Psikiyatri Anabilim Dalı, Trabzon
Nörosifilis depresyon, mani, psikoz, kişilik değişiklikleri, deliryum ve demans başta olmak üzere hemen tüm psikiyatrik bozuklukları taklit edebilir. Bugün için erken tedavi ile seyrek görülen bir hastalık olmasına rağmen, ruhsal ve nörolojik bozukluk hastalarında akılda tutulması ve serolojik tarama testlerinin düzenli uygulanması gereklidir. Nörosifilisin birçok görüngüsü geriye dönüşlüdür; hastaların gözden kaçmaması ve uygun tedavi almaları önemlidir. Yazıda demans ve duygudu-rum belirtileri ile başvuran iki nörosifilis olgusu değer¬lendirilmiştir. Önceki klinik değerlendirmelerde tam laboratuvar incelemeleri yapılmamış olan her iki olguda nörosifilis tanısı düşünülmemiştir. Penisilin tedavisi sonrası hastaların demans ve duygudurum belirtilerinde yavaş, aşamalı bir düzelme gözlenmiştir. Bu iki olgu psikiyatrik belirtilerle başvuran hastalarda, ayırıcı tanıda nörosifilisin akılda tutulması gereğine işaret etmektedir. Hastalık öyküsünün tam alınması, fiziksel, nörolojik muayene ve eşlik eden laboratuvar incelemeleri hastalığın tanınmasında temel noktadır. Klinik görünümde organik etiyoloji bakımından şüpheli tüm psikiyatri hastaları nörosifilis için uygun görülen Venereal Disease Research Laboratory, Rapid Plasma Reagin, Floresan Tropenamal Antikor Absorpsiyon tarama testleri ile değerlendirilmelidir
Two Cases with Neurosyphilis Presenting in Various Clinical Manifestations
Neurosyphilis can resemble virtually any psychiatric disorder, including depression, mania, psychosis, personality changes, delirium and dementia. Though neurosyphilis is infrequent today with early treatment, consequently a high index of suspicion and routine serologic screening of psychiatric and neurologic patients are needed. Because most manifestations of neurosyphilis are potentially reversible, it is vital that no case of the disease remain undiscovered or untreated. In this paper we report two cases with neurosyphilis which are presenting symptomatology of dementia and affective disorders. In former clinical evaluations both cases were misdiagnosed for thorough labarotary examinations were not accomplished. After treatment of neurosyphilis with penicillin, steady improvements were noted in cognitive and affective symptoms. These two cases emphasize the importance of considering neurosyphilis in differential diagnosis of patients with psychiatric symptoms. A complete history and physical and neurological examinations complemented by appropriate testing are essential. All psychiatric patients who are suspected for organic etiology should be screened for neurosyphilis with serum Veneral Disease Research Laboratory or Rapid Plasma Rreagin tests, and serum Fluorescent Treponemal Antibody - Absorption and spinal fluid studies should be obtained when neurosyphilis seems possible.

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