Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Section of Neuromuscular Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuhsing Street, Kueishan, Taoyuan, Taiwan.
Metab Brain Dis. 2017 Oct;32(5):1649-1657. doi: 10.1007/s11011-017-0055-8. Epub 2017 Jun 28.
In this study, we present the clinical manifestations, brain magnetic resonance imaging (MRI) and concurrent polyneuropathies in two patients with non-alcoholic Wernicke's encephalopathy (WE) after gastrojejunostomy (Billroth II) anastomosis procedures. These patients developed sub-acute onset of disorientation and disturbance of consciousness following several weeks of poor intake. Peripheral neuropathy of varying severity was noted before and after the onset of WE. Brain MRI of the patients showed cerebellar vermis and symmetric cortical abnormalities in addition to typical WE changes. Electrophysiological studies demonstrated axonal sensorimotor polyneuropathy. Prompt thiamine supplement therapy was initiated and both patients gradually recovered, however mild amnesia was still noted 6 months later. We reviewed non- alcoholic WE with atypical cortical abnormalities in English language literatures and identified 29 more cases. Eight out of 31 (25.8%) patients died during follow-up. Nine patients with gait disturbance or motor paresis had showed hyporeflexia in neurological examinations. In addition to classic triad, seizure was recorded in seven patients. Dietary deprivation is a risk factor for non-alcoholic WE among elderly patients receiving gastrointestinal surgery. The prognosis is good after thiamine supplement therapy. Recognizing the MRI features and predisposing factors in patients who have undergone gastrectomy can aid in the diagnosis and management.
本研究报道了 2 例胃空肠吻合术（Billroth II 式）后非酒精性 Wernicke 脑病（WE）患者的临床表现、脑部磁共振成像（MRI）和并发的多发性神经病。这 2 例患者在数周摄食不良后出现亚急性定向障碍和意识障碍。在 WE 发病前后均发现了不同程度的周围神经病。患者的脑部 MRI 显示除了典型的 WE 改变外，还存在小脑蚓部和对称的皮质异常。电生理学研究显示为轴索性感觉运动多发性神经病。及时给予了硫胺素补充治疗，2 例患者逐渐康复，但 6 个月后仍有轻度健忘。我们复习了英文文献中伴有非典型皮质异常的非酒精性 WE，并确定了另外 29 例。31 例患者中 8 例（25.8%）在随访期间死亡。9 例有步态障碍或运动性瘫痪的患者在神经检查中表现为反射减弱。除了经典三联征外，7 例患者还记录到癫痫发作。在接受胃肠手术的老年患者中，饮食摄入不足是发生非酒精性 WE 的危险因素。补充硫胺素治疗后预后良好。认识到接受胃切除术患者的 MRI 特征和易患因素有助于诊断和治疗。
