Wernicke脑病的诊断和治疗(附8例报告)

目的:探讨Wernicke脑病的诊断和治疗。方法:对8例Wernicke脑病患者的临床诊断、治疗过程进行回顾性分析、总结,并复习文献资料。结果:本组8例中4例慢性乙醇中毒,4例非乙醇中毒。临床表现:8例均有不同程度的精神和意识障碍;7例近记忆力减退;共济失调6例,为躯体共济失调,其中1例混有感觉共济失调;5例眼肌瘫痪;2例周围性感觉障碍;1例癫痫样大发作;1例体位性低血压。头颅MRI检查,1例出现第三、四脑室及中脑导水管周围、乳头体、右侧脑室枕角旁T1加权低信号,T2加权Flair相高信号;治疗后复查明显好转。1例第三脑室右侧即右侧丘脑内侧T1加权低信号,T2加权Flair相高信号,治疗后复查消失。补充大量维生素B1及其它维生素,3例治愈;4例好转,主要遗留不同程度共济失调,表现为步基宽。1例放弃治疗。结论:Wernicke脑病临床表现不典型,早期诊断、早治疗是关键。

Diagnosis and Treatment of Wernicke Encephalopathy

Objective：To explore the early diagnosis and treatment of Wernicke encephalopathy（WE）.Methods：：The pathogenesis,clinical manifestation,cranial MRI,early diagnosis and treating procedure of 8 WE patients were retrospectively analyzed.Results：Of the 8 WE patients,4 were of chronic alcoholism,and the others were of non-ethylism.All patients showed mental and conscious disturbance in different degrees;7 showed memory deterioration;6 body defective coordination including 1 of sensory incoordination;5 ophthalmoparalysis;2 peripheral sensory disturbance;1 eleptiform grand mal;and 1 postural hypotension.In cranial MRI,1 was found low signals on T1 weight（T1W） and Flair high signals on T2 W in the third and fourth cerebral ventricles,aqueduct of midbrain,bulla of fornix,and right ventricle occipital angel.After treatment,the condition of patients recovered well.The low signals on T1W and Flair high signals on T2W in the third cerebral ventricles（right medial thalamus） disappeared.After the supplementary of much vitamin B1 and other vitamins,3 cases were cured,and 4 were improved,except for certain extent incoordination.One case quitted from the treatment.Conclusion：The clinical manifestations of WE are not typical.Early diagnosis and treatment is the key for WE.