非酒精性Wernicke脑病临床特点及MRI表现

目的探讨非酒精性Wernicke脑病(WE)病人临床特点及MRI表现。方法回顾性分析经临床证实的10例非酒精性WE病人临床特点及MRI表现。结果胃肠道疾病所致反复呕吐、急性胰腺炎及妊娠剧烈呕吐为主要发病诱因。精神或意识改变为最常见临床表现。10例病人中仅1例为单发病灶,余9例均为多部位受累,病变部位包括双侧丘脑内侧及三脑室周围区(8例)、中脑导水管周围区(7例)、中脑顶盖(6例)、乳头体(4例)、四脑室底(4例)、小脑蚓部(1例)。所有病灶均于T2WI或T2FLAIR上呈对称性高信号。8例行DWI扫描,病灶呈高或稍高信号。1例行MRI增强检查,病灶呈轻度强化。4例于治疗后复查颅脑MRI,均见病灶缩小或消失。结论非酒精性WE的颅脑MRI表现具有特征性,结合病史及临床表现有助于做出早期诊断。

Clinical characteristics and MR imaging features of nonalcoholic wernicke encephalopathy

Objebtive To investigate the clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy (WE). Methods We retrospectively reviewed clinical characteristics and MR imaging features of 10 patients with nonalcoholic WE. Results The main predisposing factors included recurrent vomiting as a result of gastrointestinal disease, acute pancreatitis, and hyperemesis gravidarum. The most frequent neurologic finding was change in consciousness or mental status. On the MR images of the 10 patients, single area was involved in one cases, and multiple areas were involved in the remain 9 cases. The locations of lesions included the medial thalami and the periventricular region of the third ventricle (8 patients), the periaqueductal area (7 patients), the tectal plate (6 patients), the mamillary bodies (4 patients), the floor of forth ventricle (4 patients), and cerebellar vermis (1 patients). The findings were symmetric hyperintensity on T 2-weighted or fluid-attenuated inversion recovery images in all lesions. Eight patients who underwent diffusion-weighted imaging demonstrated increased signal intensities in the affected areas. Contrast medium was administered in one patient, and the lesions showed slight enhancement. Four patients underwent follow-up MRI after therapy, all lesions shrunked or disappeared. Conclusion Nonalcoholic WE has characteristic MRI findings. Combining with clinical characteristics, MR features are useful in early diagnosis.