Shah Irfan Ahmad, Asimi Ravouf Parvaiz, Kawoos Yuman, Wani Maqbool, Saleem Tahir, Baba Waqas Nabi
Department of Neurology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India.
J Neurosci Rural Pract. 2017 Jul-Sep;8(3):401-406. doi: 10.4103/jnrp.jnrp_14_17.
The objective of this study was to describe the demographic features, clinical presentation, and management and outcome of fifty cases of nonalcoholic Wernicke's encephalopathy from a tertiary care hospital of a region with reported incidence of thiamine deficiency disorders.
In a retrospective study, fifty adult cases of Wernicke's encephalopathy were analyzed. The diagnosis of Wernicke's encephalopathy was made according to the European federation of neurological societies guidelines 2010. Response to thiamine replacement and associated brain magnetic resonance imaging (MRI) findings were also considered as supportive evidence.
The mean age of patients was 50.38 years with 20 males and 30 females. The most common clinical manifestations were alteration in sensorium in 30 (60%), ataxia in 18 (36%), memory impairment in 15 (30%), nystagmus in 35 (70%), ophthalmoparesis in 11 (22%), and seizures in 4 (8%). A total of 42 patients had a history of recurrent vomiting. All patients had polished rice as their staple diet. Thirty-five patients had associated polyneuropathy and 15 had a gastrointestinal disorder. Twenty patients underwent MRI which showed both typical and atypical lesions. Majority of patients showed partial or complete response to intravenous thiamine. On discharge, the most common residual symptoms were lower limb weakness, ataxia, and memory impairment.
The study shows high incidence of nonalcoholic Wernicke's encephalopathy in the region with predominant causative factor being a thiamine deficient diet. Recurrent vomiting can be a prominent early symptom of thiamine deficiency and its recognition can help in the early diagnosis of Wernicke's encephalopathy and related thiamine deficiency disorders. Thiamine fortification of food should be done in areas with reported incidence of thiamine deficiency disorders.
本研究的目的是描述一家三级护理医院中50例非酒精性韦尼克脑病患者的人口统计学特征、临床表现、治疗及预后情况，该地区有硫胺素缺乏症的报告发病率。
在一项回顾性研究中，对50例成人韦尼克脑病病例进行了分析。韦尼克脑病的诊断依据2010年欧洲神经学会联合会指南。硫胺素替代治疗的反应以及相关的脑磁共振成像（MRI）结果也被视为支持证据。
患者的平均年龄为50.38岁，其中男性20例，女性30例。最常见的临床表现为意识改变30例（60%）、共济失调18例（36%）、记忆障碍15例（30%）、眼球震颤35例（70%）、眼肌麻痹11例（22%）、癫痫发作4例（8%）。共有42例患者有反复呕吐史。所有患者均以精米为主食。35例患者伴有多发性神经病，15例有胃肠道疾病。20例患者接受了MRI检查，显示出典型和非典型病变。大多数患者对静脉注射硫胺素显示出部分或完全反应。出院时，最常见的残留症状是下肢无力、共济失调和记忆障碍。
该研究表明该地区非酒精性韦尼克脑病的发病率较高，主要致病因素是硫胺素缺乏饮食。反复呕吐可能是硫胺素缺乏的突出早期症状，认识到这一点有助于早期诊断韦尼克脑病及相关硫胺素缺乏症。在有硫胺素缺乏症报告发病率的地区应进行食品硫胺素强化。
