Kellogg Eye Center and Department of Ophthalmology and Vision Sciences, University of Michigan, Ann Arbor, Michigan 48105, USA.
J Neuroophthalmol. 2010 Mar;30(1):54-8. doi: 10.1097/WNO.0b013e3181ceb4d0.
A young woman who underwent gastric bypass surgery for morbid obesity had intractable nausea and vomiting for several weeks postoperatively, leading to poor intake and excessive weight loss. In the ninth postoperative week, she became confused and off balance and reported blurred and double vision. Examination disclosed slow saccades, nystagmus, and impaired abduction of both eyes as well as memory loss and ataxia. Visual acuity was slightly subnormal, and ophthalmoscopy disclosed a thickened and telangiectatic peripapillary nerve fiber layer with retinal hemorrhages. MRI showed high T2 and FLAIR signal in the dorsomedial thalamus and mamillary bodies bilaterally, substantiating a clinical diagnosis of Wernicke encephalopathy (WE). After thiamine treatment, visual acuity returned to normal and eye movements and alignment almost completely normalized. Fundus abnormalities eventually regressed. Although the ocular motor findings of WE have been well documented, the ophthalmoscopic findings have not. Resembling the findings in Leber hereditary and toxic optic neuropathies, they may represent manifestations of impaired mitochondrial function in retinal ganglion cells and capillaries. Recognition that these ophthalmoscopic findings may occur in WE is important to avoid procedures such as lumbar puncture that may delay urgent treatment with thiamine.
一位年轻女性因病态肥胖接受了胃旁路手术，术后数周出现顽固性恶心和呕吐，导致摄入不足和体重过度下降。在术后第 9 周，她变得神志不清和失去平衡，并报告视力模糊和复视。检查发现眼球缓慢扫视、眼球震颤和双眼外展功能受损，伴有记忆力减退和共济失调。视力略低于正常，眼底检查显示视盘周围神经纤维层增厚和扩张，伴有视网膜出血。MRI 显示双侧丘脑背内侧和乳头体 T2 和 FLAIR 信号增高，证实了韦尼克脑病（WE）的临床诊断。给予硫胺素治疗后，视力恢复正常，眼球运动和对齐几乎完全正常。眼底异常最终消退。尽管 WE 的眼球运动表现已有充分记录，但眼底表现尚未记录。这些眼底表现类似于 Leber 遗传性视神经病变和中毒性视神经病变，可能代表视网膜神经节细胞和毛细血管中线粒体功能受损的表现。认识到这些眼底表现可能发生在 WE 中很重要，以避免腰椎穿刺等可能延迟硫胺素紧急治疗的程序。
