Wernicke脑病的临床、影像学及病理特点

目的探讨Wernicke脑病的临床、影像学及病理特点。方法回顾性分析10例Wernicke脑病患者的临床、影像学及病理资料。结果本组10例均非乙醇中毒患者,临床表现为不同程度的精神及意识障碍9例,首发症状为眩晕、恶心和呕吐6例,眼肌瘫痪5例,低血压3例,共济失调2例,严重的周围神经病变1例。5例行头颅MRI检查,3例表现为第三、四脑室及中脑导水管周围对称性的长T1长T2异常信号,2例无阳性发现。经补充维生素B1明显好转4例,死亡5例,放弃治疗1例。5例尸检脑部表现为第三、四脑室及中脑导水管周围灰质充血、水肿和点状出血。结论Wernicke脑病临床表现不典型,MRI检查可为Wernicke脑病的早期诊断提供帮助,及早补充维生素B1是治疗的关键。

Clinical,image and pathological features of Wernicke's encephalopathy

Objective To investigate the clinical, imaging and pathological features of Wernicke's encephalopathy (WE).Methods The clinical, imaging and pathologic datas of 10 patients with WE were analyzed retrospectively.Results 10 patients were not ethylism. 9 cases presented various mental and conscious disturbance, 6 cases initially presented vertigo, nausea and vomiting. 5 cases showed ophthalmoparalysis. 3 cases displayed hypotension.2 cases showed ataxia and 1 case showed severe peripheral neuropathy. 3 of the 5 patients with MRI examinations showed symmetric T_1 and T_2 high signal in encephalocoele and periphery of aqueduct of midbrain, the other 2 cases were no positive finding . 4 cases with supplement VitB_1 were cured, 5 cases died.1 case withdrawed. 5 autopsy cases showed congestion, edema and multiple petechial hemorrhages in encephalocoele and periphery of aqueduct of midbrain.Conclusions The clinical manifestation of WE is atypical, and MRI imaging is helpful for early diagnosis of WE. It is the key treatment to supply the thiamine as early as possible.