Zhang Zhaoqian, Li Xiao, Yang Mei
Internal Medicine, St. Luke's Hospital, Chesterfield, USA.
Cureus. 2024 Jul 9;16(7):e64192. doi: 10.7759/cureus.64192. eCollection 2024 Jul.
Wernicke's encephalopathy (WE) is a prominent neurologic manifestation of thiamine (vitamin B1) deficiency. While often linked to alcoholism, it can also arise from various causes, including malabsorption, inadequate dietary intake, increased metabolic requirement, and among dialysis patients. Here, we present a case of altered mental status from acute metabolic encephalopathy attributed to sepsis, acute kidney injury (AKI), and hypoglycemia. WE was overlooked in the early hospitalization course due to the daily administration of thiamine. However, the patient's cognitive decline persisted despite the improvement of sepsis and AKI. Subsequent brain MRI revealed thalamic T2 signal intensity changes, suggesting either a past infarction or WE. Implementing an empirical regimen of high-dose thiamine resulted in the patient's rapid cognitive recovery. This therapeutic strategy was integrated into the management of her sepsis and AKI, leading to her full recovery and subsequent hospital discharge without complications.
韦尼克脑病（WE）是硫胺素（维生素B1）缺乏的一种突出的神经表现。虽然它常与酒精中毒有关，但也可由多种原因引起，包括吸收不良、饮食摄入不足、代谢需求增加以及在透析患者中。在此，我们报告一例因脓毒症、急性肾损伤（AKI）和低血糖导致急性代谢性脑病而出现精神状态改变的病例。由于每日补充硫胺素，在住院早期病程中韦尼克脑病被忽视。然而，尽管脓毒症和急性肾损伤有所改善，但患者的认知功能减退仍持续存在。随后的脑部磁共振成像（MRI）显示丘脑T2信号强度改变，提示既往梗死或韦尼克脑病。实施大剂量硫胺素的经验性治疗方案后，患者的认知功能迅速恢复。这种治疗策略被纳入她的脓毒症和急性肾损伤的管理中，使其完全康复并随后顺利出院，无并发症。
