Iwamoto Y, Okuda B, Miyata Y, Tachibana H, Sugita M
Fifth Department of Internal Medicine, Hyogo College of Medicine.
Rinsho Shinkeigaku. 1994 Jun;34(6):599-601.
A 25-year-old woman suffered from hyperemesis gravidarum when she was seven weeks pregnant. Since her vomiting continued, she received intravenous dextrose and electrolytes without thiamine in a hospital. One month later, she developed gait disturbance, followed by confusion and dysarthria. On admission to our department, she was confusional and had ataxic dysarthria. Spontaneous and gaze evoked nystagmus was present. Limb coordination was bilaterally ataxic. Based on her clinical course and symptoms, she was diagnosed as having Wernicke's encephalopathy. From the admission day, intravenous infusion of vitamin B1 (600 mg/day) was started. A few days later, her consciousness and limb ataxia began to improve. However, truncal ataxia and polyneuropathy became evident. Eight weeks after onset, she developed Korsakoff's psychosis such as anterograde and retrograde amnesia, disorientation and confabulation. We administered large amounts of corticosteroid (methylprednisolone 500 mg/day) in order to reduce brain edema or stabilize the impaired blood-brain barrier. Soon after, her psychosis began to improve gradually. She recovered remarkably from the psychosis, but she was left with persistent nystagmus, mild ataxic gait and polyneuropathy. The present case suggests that corticosteroid may have the beneficial effect on Wernicke-Korsakoff syndrome.
一名25岁女性在怀孕7周时出现妊娠剧吐。由于呕吐持续，她在一家医院接受了不含硫胺素的静脉葡萄糖和电解质治疗。1个月后，她出现步态障碍，随后出现意识模糊和构音障碍。入院时，她意识模糊，存在共济失调性构音障碍。有自发性和凝视诱发的眼球震颤。双侧肢体协调性共济失调。根据她的临床病程和症状，她被诊断为韦尼克脑病。从入院当天起，开始静脉输注维生素B1（600毫克/天）。几天后，她的意识和肢体共济失调开始改善。然而，躯干共济失调和多发性神经病变得明显。发病8周后，她出现了柯萨科夫精神病，如顺行性和逆行性遗忘、定向障碍和虚构。我们给予大量皮质类固醇（甲泼尼龙500毫克/天）以减轻脑水肿或稳定受损的血脑屏障。此后不久，她的精神病开始逐渐改善。她从精神病中显著康复，但仍遗留持续性眼球震颤、轻度共济失调步态和多发性神经病。本病例提示皮质类固醇可能对韦尼克-柯萨科夫综合征有有益作用。
