Department of Emergency, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
J Zhejiang Univ Sci B. 2010 Jun;11(6):433-6. doi: 10.1631/jzus.B1000016.
To report a case of Wernicke encephalopathy in the early stage after surgery.
A nonalcoholic female patient with hepatitis B-related cirrhosis and hypersplenism underwent splenectomy in a local hospital. No surgical complications occurred and the patient recovered well. However, on the eighth postoperative day she developed psychiatric and neurological disturbance without an obvious cause. She was then admitted to our hospital. Brain magnetic resonance imaging (MRI) with FLAIR T2 showed symmetric high-signal intensities in the periaqueductal area of the midbrain, which were consistent with Wernicke encephalopathy. She was thus given intramuscular thiamine immediately.
After the administration of thiamine, the patient's confused mental state resolved within 3 d, and her dystaxia gradually improved over the next 5 d. The brain MRI with FLAIR T2 was re-examined one month after the episode, and showed nearly complete resolution of the previously abnormal signal intensities in the periaqueductal area of the midbrain.
Physicians should be aware of the possibility of acute Wernicke encephalopathy, especially in patients with liver dysfunction.
报告一例术后早期的 Wernicke 脑病。
一位非酒精性女性乙型肝炎相关肝硬化伴脾功能亢进患者在当地医院行脾切除术。无手术并发症，患者恢复良好。然而，术后第 8 天，她出现了无明显诱因的精神和神经系统紊乱，随后转入我院。脑磁共振成像（MRI）FLAIR T2 显示中脑导水管周围区呈对称性高信号强度，符合 Wernicke 脑病。立即给予肌内注射硫胺素。
给予硫胺素后，患者的意识混乱状态在 3 天内得到缓解，共济失调在接下来的 5 天内逐渐改善。发病一个月后再次进行 FLAIR T2 脑 MRI 检查，显示中脑导水管周围区先前异常信号强度几乎完全缓解。
医生应意识到急性 Wernicke 脑病的可能性，尤其是在肝功能异常的患者中。
