Larsen Timothy R, Dragu Dritan, Williams Michael
Department of Internal Medicine, Providence Hospital and Medical Centers, 16001 West Nine Mile Road, Southfield, MI 48075, USA.
Case Rep Med. 2013;2013:709474. doi: 10.1155/2013/709474. Epub 2013 Jul 9.
Introduction. Wernicke's encephalopathy is a well-described syndrome characterized by the classic triad of confusion, ataxia, and ophthalmoplegia. Wernicke's encephalopathy results from thiamine (vitamin B1) deficiency. Common causes include alcoholism and gastric disorders. Wernicke's has been described in patients with acquired immune deficiency syndrome (AIDS); however, given these patients' immunosuppressed state, the diagnosis of Wernicke's encephalopathy is not apparent. Case Presentation. A 31-year-old previously healthy male presented to the ER complaining of progressive dyspnea. Workup revealed HIV/AIDS and PCP pneumonia. He was treated and improved. On day 14 he became confused and developed nystagmus and ataxia. Considering his immunocompromised state, infectious and neoplastic etiologies topped the differential diagnosis. CT head was negative. Lumbar puncture was unremarkable. Brain MRI revealed increased T2 signal in the medial thalamus bilaterally. Intravenous thiamine was administered resulting in resolution of symptoms. Discussion. The classic triad of Wernicke's encephalopathy occurs in 10% of cases. When immunosuppressed patients develop acute neurologic symptoms infectious or neoplastic etiologies must be excluded. However, given the relative safety of thiamine supplementation, there should be a low threshold for initiating therapy in order to reverse the symptoms and prevent progression to Korsakoff dementia, which is permanent.
引言。韦尼克脑病是一种已被充分描述的综合征，其特征为具有精神错乱、共济失调和眼肌麻痹这一典型三联征。韦尼克脑病由硫胺素（维生素B1）缺乏所致。常见病因包括酒精中毒和胃部疾病。韦尼克脑病在获得性免疫缺陷综合征（艾滋病）患者中已有报道；然而，鉴于这些患者的免疫抑制状态，韦尼克脑病的诊断并不明显。病例报告。一名31岁既往健康的男性因进行性呼吸困难就诊于急诊室。检查发现患有艾滋病毒/艾滋病和肺孢子菌肺炎。他接受了治疗并有所好转。在第14天，他出现精神错乱，并伴有眼球震颤和共济失调。考虑到他的免疫功能低下状态，感染性和肿瘤性病因在鉴别诊断中居首位。头颅CT检查结果为阴性。腰椎穿刺检查无异常。脑部磁共振成像显示双侧内侧丘脑T2信号增强。给予静脉注射硫胺素后症状缓解。讨论。韦尼克脑病的典型三联征仅在10%的病例中出现。当免疫抑制患者出现急性神经症状时，必须排除感染性或肿瘤性病因。然而，鉴于补充硫胺素相对安全，启动治疗的阈值应较低，以便逆转症状并防止进展为永久性的科萨科夫痴呆。
