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由于酒精使用障碍患者维生素 D 缺乏导致 Wernicke 脑病和肌肉减少症同时发生:病例报告。

Concomitant occurrence of Wernicke's encephalopathy and sarcopenia due to vitamin D depletion in patients with alcohol use disorder: a case report.

机构信息

First Department of Internal Medicine, Univerzita Pavla Jozefa Šafárika v Košiciach, Košice, Slovakia.

Department of Neurosurgery, Univerzita Pavla Jozefa Šafárika v Košiciach, Košice, Slovakia.

出版信息

J Int Med Res. 2023 Jun;51(6):3000605231182262. doi: 10.1177/03000605231182262.

Abstract

Individuals with alcohol use disorder frequently suffer from vitamin D deficiency, in addition to deficiencies in vitamins B12, folic acid and B1. This is due to inadequate dietary intake and behavioural changes. Each of these deficiencies results in different clinical symptoms. Subacute spinal cord degeneration, together with radicular and sensorimotor peripheral neuropathy, arises from B12 vitamin and folic acid deficiencies. B1 vitamin deficiency leads to Wernicke's encephalopathy, which can include the classical triad of symptoms (i.e. cognitive changes, ataxia and ophthalmoplegia). Sarcopenia is a consequence of a long-term deficiency of vitamin D. This current case report describes a 43-year-old female patient with alcohol use disorder who complained of dizziness, postural disturbance and episodes of intermittent paraesthesia. She was subsequently shown to have concomitant Wernicke's encephalopathy and sarcopenia due to vitamin D deficiency. This case report presents the diagnostic process undertaken to exclude conditions related to ataxia and paraparesis other than vitamins D and B1 deficiencies. It also emphasizes the importance of concomitant replacement of the depleted vitamins because the vitamin deficiency may occur simultaneously, which causes the accompanying manifestations of several clinical syndromes.

摘要

患有酒精使用障碍的个体经常同时缺乏维生素 D、维生素 B12、叶酸和 B1,此外还存在这些维生素的缺乏。这是由于饮食摄入不足和行为改变所致。这些缺乏症中的每一种都会导致不同的临床症状。维生素 B12 和叶酸缺乏会导致亚急性脊髓退行性变,以及神经根和感觉运动性周围神经病。维生素 B1 缺乏会导致 Wernicke 脑病,其可能包括经典三联征(即认知改变、共济失调和眼肌麻痹)。维生素 D 长期缺乏会导致肌肉减少症。本病例报告描述了一名 43 岁的女性酒精使用障碍患者,她主诉头晕、姿势不稳和间歇性感觉异常。随后发现她同时患有维生素 D 缺乏导致的 Wernicke 脑病和肌肉减少症。本病例报告介绍了为排除除维生素 D 和 B1 缺乏以外的与共济失调和截瘫相关的疾病而进行的诊断过程。它还强调了同时补充耗竭的维生素的重要性,因为维生素缺乏可能同时发生,从而导致几种临床综合征的伴随表现。

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Don't seek, don't find: The diagnostic challenge of Wernicke's encephalopathy.勿寻勿觅:Wernicke 脑病的诊断挑战。
Ann Clin Biochem. 2021 Jan;58(1):38-46. doi: 10.1177/0004563220939604. Epub 2020 Jul 13.
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Alcoholism and nutrition: a review of vitamin supplementation and treatment.酒精中毒与营养:维生素补充与治疗综述。
Curr Opin Clin Nutr Metab Care. 2020 Mar;23(2):138-144. doi: 10.1097/MCO.0000000000000622.
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Ataxia.共济失调
Continuum (Minneap Minn). 2019 Aug;25(4):1036-1054. doi: 10.1212/CON.0000000000000753.

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