目的：通过分析和总结神经梅毒患者的临床特征，旨在减少神经梅毒的临床误诊。 方法：回顾性分析2013年1月—2017年1月上海交通大学医学院附属仁济医院神经内科收治的24例神经梅毒患者的临床资料。 结果：24例神经梅毒患者中，男性21例，女性3例；中位年龄为55岁（范围：28～75岁）；首发临床表现为癫痫者3例，麻痹型痴呆者3例，脑血管病样发作者5例，有脊髓症状者5例。24例患者的血清梅毒螺旋体明胶颗粒凝集试验（treponema pallidum particle assay，TPPA）和非梅毒螺旋体抗原血清试验——甲苯胺红不加热血清试验（tolulized red unheated serum test，TRUST）以及脑脊液TPPA均为阳性。其中，脑脊液细胞计数异常者21例，蛋白含量增加者20例。头颅计算机断层成像（computed tomography，CT）和磁共振成像（magnetic resonance imaging，MRI）显示腔隙脑梗死10例，急性脑梗死3例，脑出血1例，血管狭窄、变细、不显影5例，核团异常信号1例，脊髓感染性肉芽肿1例，脊髓异常信号1例，脑叶异常信号2例，脑萎缩和海马萎缩2例，颅内无异常表现4例。所有患者在确诊神经梅毒后均立即接受青霉素治疗，症状好转。 结论：通过结合临床表现、实验室检查及影像学检查，有助于减少神经梅毒的误诊。

Objective: Through the analysis and summary of the clinical features of neurosyphilis, this study aims to give references for reducing the clinical misdiagnosis of neurosyphilis. Methods: A retrospective analysis of the clinical data of 24 cases of neurosyphilis in Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to January 2017 was conducted. Results: Of 24 cases of neurosyphilis, 21 cases were males, 3 were females; the median age was 55 years (range: 28 to 75 years); 3 cases had the first clinical manifestation of epilepsy, 3 cases had paralytic dementia, 5 cases had cerebral vascular disease-like attack, and 5 cases had spinal cord symptoms. Twenty-four cases had positive results of serum treponema pallidum particle agglutination test (TPPA) and toluidine red unheated serum test (TRUST) as well as cerebrospinal fluid TPPA. There were 21 cases had abnormal count of cerebrospinal fluid cells and 20 cases had increased protein content. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) showed 10 cases had lacunar infarction, 3 cases had acute cerebral infarction, 1 case had cerebral hemorrhage, 5 cases had vascular stenosis, thinning and absence, 1 case had nucleus abnormal signal, 1 case had spinal cord infectious granuloma, 1 case had spinal cord abnormal signal, 2 cases had brain lobe abnormal signal, 2 cases had brain atrophy and hippocampal atrophy, and 4 cases had no abnormal intracranial findings. All the patients received penicillin treatment immediately after the diagnosis of neurosyphilis was confirmed, and the symptoms were relieved after treatment. Conclusion: Combination of clinical manifestations with laboratory and imaging could help to reduce the misdiagnosis of neurosyphilis.