Truong Tiffany, Hetzel Fredrick, Stiff Katherine M, Husnain Muhammad Ghazanfar
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
MetroHealth Medical Center, Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
BMJ Case Rep. 2021 Mar 17;14(3):e239886. doi: 10.1136/bcr-2020-239886.
Thiamine is an essential cofactor in the process of nucleic acid synthesis. Neuronal tissues are especially sensitive to thiamine deficiency, manifesting as Wernicke's encephalopathy (WE). The typical triad of WE, encephalopathy, oculomotor dysfunction and gait ataxia, is only present in less than one-third of the cases. We present the case of a middle-aged man with hypoactive delirium due to presumed thiamine deficiency, who had a prolonged hospital course and a delayed diagnosis of the cause of altered mental status. The presentation of this disorder solely as a decreased level of consciousness is uncommon but has been reported in the literature. It is essential to recognise WE as a treatable condition that may manifest only as a hypoactive delirium. The delay in the diagnosis and treatment may lead to coma and death.
硫胺素是核酸合成过程中一种必需的辅助因子。神经组织对硫胺素缺乏特别敏感，表现为韦尼克脑病（WE）。WE典型的三联征，即脑病、动眼神经功能障碍和步态共济失调，仅在不到三分之一的病例中出现。我们报告了一例因推测硫胺素缺乏导致谵妄活动减退的中年男性病例，该患者住院病程延长，精神状态改变的病因诊断延迟。这种疾病仅表现为意识水平下降并不常见，但文献中已有报道。认识到WE是一种可治疗的疾病，且可能仅表现为谵妄活动减退至关重要。诊断和治疗的延迟可能导致昏迷和死亡。
