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Случай энцефалопатии Вернике неалкогольного генеза
Случай энцефалопатии Вернике неалкогольного генеза
Сердюк А.В., Ковражкина Е.А., Абрамова Н.Г. Случай энцефалопатии Вернике неалкогольного генеза. Consilium Medicum. 2019; 21 (9): 44–47. DOI: 10.26442/20751753.2019.9.190458
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Аннотация
Энцефалопатия Вернике (ЭВ) – труднораспознаваемое, но потенциально курабельное с помощью высоких доз тиамина заболевание, относящиеся к ургентным состояниям. При отсутствии специфического лечения либо при позднем его начале ЭВ переходит в синдром Корсакова (синдром Вернике–Корсакова). Хотя ЭВ чаще всего развивается у пациентов с алкоголизмом, многие случаи ЭВ имеют неалкогольный генез. Представляем случай ЭВ у пациентки 46 лет, отрицающей злоупотребление алкоголем, но имеющей в анамнезе ограничения в питании с выраженным похудением, что, по-видимому, и стало причиной дефицита тиамина. Проводился дифференциальный диагноз с инсультом, стволовым энцефалитом, синдромом Миллера–Фишера. Несмотря на проведенное лечение, даже через 4 мес после выписки из стационара у пациентки сохраняются атактические и мнестические нарушения. Представленный случай демонстрирует трудности диагностики ЭВ у пациентов без явного алкогольного анамнеза.
Ключевые слова: энцефалопатия Вернике, дефицит тиамина, мнестические нарушения.
Ключевые слова: энцефалопатия Вернике, дефицит тиамина, мнестические нарушения.
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Wernike's encephalopathy (WE) is a difficult to recognize, but potentially curable disease with high doses of thiamine, related to urgent conditions. In the absen-ce of specific treatment, or at a late start, WE turns into Korsakov syndrom (Wernike–Korsakov syndrom). Although WE most often develops in patients with alcoholism, many of WE cases have non-alcoholic genesis. We present the case of WE in a 46-year-old patient who denies alcohol abuse but has a history of food restriction with significant weight loss, which, apparently, was the cause of thiamine deficiency. Differential diagnosis was performed with stroke, stem encephalitis and Miller–Phisher syndrom. Despite the treatment, even after 4 months after discharge from the hospital, the patient still has atactic and mnestic disorders. The presented case demonstrates the difficulty of diagnosing WE in patients without a clear alcoholic history.
Key words: Wernike's encephalopathy, thiamine deficiency, mnestic disorders.
Key words: Wernike's encephalopathy, thiamine deficiency, mnestic disorders.
Полный текст
Список литературы
1. Сиволап Ю.П., Дамулин И.В. Энцефалопатия Вернике и корсаковский психоз: клинико-патогенетические соотношения, диагностика и лечение. Журн. неврологии и психиатрии им. С.С.Корсакова. 2013; 6 (2): 20–6.
[Sivolap Iu.P., Damulin I.V. Entsefalopatiia Vernike i korsakovskii psikhoz: kliniko-patogeneticheskie sootnosheniia, diagnostika i lechenie. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2013; 6 (2): 20–6 (in Russian).]
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[Sivolap Iu.P., Damulin I.V. Sindrom Vernike–Korsakova. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2014; 4: 76–80 (in Russian).]
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[Grigor'eva V.N., Guzanova E.V., Mukhin V.V. Entsefalopatiia Vernike, tsentral'nyi pontinnyi mielinoliz, i polinevropatiia u bol'nykh s neukrotimoi rvotoi beremennykh (hyperemesis gravidarum). Nevrol. zhurn. 2016; 3: 131–41. DOI: 10.18821/1560-9545-2016-21-3-131-141 (in Russian).]
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7. Chang HW, Yang PY, Han TI, Meng NH. Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery: a case report. Medicine (Baltimore) 2019; 98 (10): e14808. DOI: 10.1097/MD.0000000000014808
8. Nagarajan E, Rupareliya C, Bollu P. Wernicke’s encephalopathy as a rare complication of hyperemesis gravidarum: a case report and review of literature. Cureus 2018; 10 (5): e2597. DOI: 10.7759/cureus.2597
9. Talib V, Sultana S, Hamad A, Yaqoob U. Wernicke encephalopathy due to hyperemesis gravidarum in pregnancy: a case report. Cureus 2018; 10 (7): e2991. DOI: 10.7759/cureus.2991
10. Gungor Doğan İ, Uzun Altıokka G, Turker F et al. Wernicke’s encephalopathy due to non-alcoholic gastrointestinal tract disease. Arch Neuropsychiatry 2018; 55: 307–14.
11. Oudman E, Wijnia JW, van Dam M et al. Preventing Wernicke encephalopathy after bariatric surgery. Obesity Surgery 2018; 28: 2060–8.
12. Hamilton LA, Darby SH, Hamilton AJ et al. Case report of Wernicke's encephalopathy after sleeve gastrectomy. Nutr Clin Pract 2018; 33 (4): 510–4. DOI: 10.1177/0884533617722758
13. Tan TXZ, Lim KC, Chan Chung S, Aung T. Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy. BMJ Case Rep 2019; 12 (1).
14. Karakonstantis S, Galani D, Korela D et al. Missing the early signs of thiamine deficiency. A case associated with a liquid-only diet. Nutr Neurosci 2018; 1–3. DOI: 10.1080/1028415X.2018.1507964
15. Onishi H, Ishida M, Uchida N et al. Thiamine deficiency observed in a cancer patient's caregiver. Palliat Support Care 2019; 1–3. DOI: 10.1017/S1478951518001001
16. Oudman E, Wijnia JW, Oey MJ et al. Preventing Wernicke's encephalopathy in anorexia nervosa: a systematic review. Psychiatry Clin Neurosci 2018; 72 (10): 774–9. DOI: 10.1111/pcn.12735
17. Onishi H, Ishida M, Kagamu H et al. Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliat Support Care 2018; 1–3. DOI: 10.1017/S1478951518000469
18. Davies SB., Joshua FF., Zagami AS. Wernicke’s encephalopathy in a nonalcoholic patient with a normal blood thiamine level. Med J Aust 2011; 194 (9): 483–4.
19. Manzo G, De Gennaro A, Cozzolino A et al. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int 2014; 24: 503–96.
20. Latt N, Dore G. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Intern Med J 2014; 44 (9): 911–5. DOI: 10.1111/imj.12522
21. Abbas SA, Abboud H, Chalah MA et al. Isolated mammillary bodies damage – an atypical presentation of Wernicke syndrome. Behav Sci 2018; 8 (104). DOI: 10.3390/bs8110104
2. Sivolap Iu.P., Damulin I.V. Sindrom Vernike–Korsakova. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2014; 4: 76–80 (in Russian).
3. Victor M, Adams RD, Collins GH. The Wernicke–Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with postmortem examinations. Contemp Neurol Ser 1971; 7: 1–206.
4. Grigor'eva V.N., Guzanova E.V., Mukhin V.V. Entsefalopatiia Vernike, tsentral'nyi pontinnyi mielinoliz, i polinevropatiia u bol'nykh s neukrotimoi rvotoi beremennykh (hyperemesis gravidarum). Nevrol. zhurn. 2016; 3: 131–41. DOI: 10.18821/1560-9545-2016-21-3-131-141 (in Russian).
5. Day GS, del Campo CM. Wernicke encephalopathy: a medical emergency. CMAJ 2014; 186 (8).
6. Lough ME. Wernicke’s encephalopathy: expanding the diagnostic toolbox. Neuropsychol Rev 2012; 22 (2): 181–94.
7. Chang HW, Yang PY, Han TI, Meng NH. Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery: a case report. Medicine (Baltimore) 2019; 98 (10): e14808. DOI: 10.1097/MD.0000000000014808
8. Nagarajan E, Rupareliya C, Bollu P. Wernicke’s encephalopathy as a rare complication of hyperemesis gravidarum: a case report and review of literature. Cureus 2018; 10 (5): e2597. DOI: 10.7759/cureus.2597
9. Talib V, Sultana S, Hamad A, Yaqoob U. Wernicke encephalopathy due to hyperemesis gravidarum in pregnancy: a case report. Cureus 2018; 10 (7): e2991. DOI: 10.7759/cureus.2991
10. Gungor Doğan İ, Uzun Altıokka G, Turker F et al. Wernicke’s encephalopathy due to non-alcoholic gastrointestinal tract disease. Arch Neuropsychiatry 2018; 55: 307–14.
11. Oudman E, Wijnia JW, van Dam M et al. Preventing Wernicke encephalopathy after bariatric surgery. Obesity Surgery 2018; 28: 2060–8.
12. Hamilton LA, Darby SH, Hamilton AJ et al. Case report of Wernicke's encephalopathy after sleeve gastrectomy. Nutr Clin Pract 2018; 33 (4): 510–4. DOI: 10.1177/0884533617722758
13. Tan TXZ, Lim KC, Chan Chung S, Aung T. Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy. BMJ Case Rep 2019; 12 (1).
14. Karakonstantis S, Galani D, Korela D et al. Missing the early signs of thiamine deficiency. A case associated with a liquid-only diet. Nutr Neurosci 2018; 1–3. DOI: 10.1080/1028415X.2018.1507964
15. Onishi H, Ishida M, Uchida N et al. Thiamine deficiency observed in a cancer patient's caregiver. Palliat Support Care 2019; 1–3. DOI: 10.1017/S1478951518001001
16. Oudman E, Wijnia JW, Oey MJ et al. Preventing Wernicke's encephalopathy in anorexia nervosa: a systematic review. Psychiatry Clin Neurosci 2018; 72 (10): 774–9. DOI: 10.1111/pcn.12735
17. Onishi H, Ishida M, Kagamu H et al. Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliat Support Care 2018; 1–3. DOI: 10.1017/S1478951518000469
18. Davies SB., Joshua FF., Zagami AS. Wernicke’s encephalopathy in a nonalcoholic patient with a normal blood thiamine level. Med J Aust 2011; 194 (9): 483–4.
19. Manzo G, De Gennaro A, Cozzolino A et al. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int 2014; 24: 503–96.
20. Latt N, Dore G. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Intern Med J 2014; 44 (9): 911–5. DOI: 10.1111/imj.12522
21. Abbas SA, Abboud H, Chalah MA et al. Isolated mammillary bodies damage – an atypical presentation of Wernicke syndrome. Behav Sci 2018; 8 (104). DOI: 10.3390/bs8110104
[Sivolap Iu.P., Damulin I.V. Entsefalopatiia Vernike i korsakovskii psikhoz: kliniko-patogeneticheskie sootnosheniia, diagnostika i lechenie. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2013; 6 (2): 20–6 (in Russian).]
2. Сиволап Ю.П., Дамулин И.В. Синдром Вернике–Корсакова. Неврология, нейропсихиатрия, психосоматика. 2014; 4: 76–80.
[Sivolap Iu.P., Damulin I.V. Sindrom Vernike–Korsakova. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2014; 4: 76–80 (in Russian).]
3. Victor M, Adams RD, Collins GH. The Wernicke–Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with postmortem examinations. Contemp Neurol Ser 1971; 7: 1–206.
4. Григорьева В.Н., Гузанова Е.В., Мухин В.В. Энцефалопатия Вернике, центральный понтинный миелинолиз, и полиневропатия у больных с неукротимой рвотой беременных (hyperemesis gravidarum). Неврол. журн. 2016; 3: 131–41. DOI: 10.18821/1560-9545-2016-21-3-131-141.
[Grigor'eva V.N., Guzanova E.V., Mukhin V.V. Entsefalopatiia Vernike, tsentral'nyi pontinnyi mielinoliz, i polinevropatiia u bol'nykh s neukrotimoi rvotoi beremennykh (hyperemesis gravidarum). Nevrol. zhurn. 2016; 3: 131–41. DOI: 10.18821/1560-9545-2016-21-3-131-141 (in Russian).]
5. Day GS, del Campo CM. Wernicke encephalopathy: a medical emergency. CMAJ 2014; 186 (8).
6. Lough ME. Wernicke’s encephalopathy: expanding the diagnostic toolbox. Neuropsychol Rev 2012; 22 (2): 181–94.
7. Chang HW, Yang PY, Han TI, Meng NH. Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery: a case report. Medicine (Baltimore) 2019; 98 (10): e14808. DOI: 10.1097/MD.0000000000014808
8. Nagarajan E, Rupareliya C, Bollu P. Wernicke’s encephalopathy as a rare complication of hyperemesis gravidarum: a case report and review of literature. Cureus 2018; 10 (5): e2597. DOI: 10.7759/cureus.2597
9. Talib V, Sultana S, Hamad A, Yaqoob U. Wernicke encephalopathy due to hyperemesis gravidarum in pregnancy: a case report. Cureus 2018; 10 (7): e2991. DOI: 10.7759/cureus.2991
10. Gungor Doğan İ, Uzun Altıokka G, Turker F et al. Wernicke’s encephalopathy due to non-alcoholic gastrointestinal tract disease. Arch Neuropsychiatry 2018; 55: 307–14.
11. Oudman E, Wijnia JW, van Dam M et al. Preventing Wernicke encephalopathy after bariatric surgery. Obesity Surgery 2018; 28: 2060–8.
12. Hamilton LA, Darby SH, Hamilton AJ et al. Case report of Wernicke's encephalopathy after sleeve gastrectomy. Nutr Clin Pract 2018; 33 (4): 510–4. DOI: 10.1177/0884533617722758
13. Tan TXZ, Lim KC, Chan Chung S, Aung T. Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy. BMJ Case Rep 2019; 12 (1).
14. Karakonstantis S, Galani D, Korela D et al. Missing the early signs of thiamine deficiency. A case associated with a liquid-only diet. Nutr Neurosci 2018; 1–3. DOI: 10.1080/1028415X.2018.1507964
15. Onishi H, Ishida M, Uchida N et al. Thiamine deficiency observed in a cancer patient's caregiver. Palliat Support Care 2019; 1–3. DOI: 10.1017/S1478951518001001
16. Oudman E, Wijnia JW, Oey MJ et al. Preventing Wernicke's encephalopathy in anorexia nervosa: a systematic review. Psychiatry Clin Neurosci 2018; 72 (10): 774–9. DOI: 10.1111/pcn.12735
17. Onishi H, Ishida M, Kagamu H et al. Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliat Support Care 2018; 1–3. DOI: 10.1017/S1478951518000469
18. Davies SB., Joshua FF., Zagami AS. Wernicke’s encephalopathy in a nonalcoholic patient with a normal blood thiamine level. Med J Aust 2011; 194 (9): 483–4.
19. Manzo G, De Gennaro A, Cozzolino A et al. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int 2014; 24: 503–96.
20. Latt N, Dore G. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Intern Med J 2014; 44 (9): 911–5. DOI: 10.1111/imj.12522
21. Abbas SA, Abboud H, Chalah MA et al. Isolated mammillary bodies damage – an atypical presentation of Wernicke syndrome. Behav Sci 2018; 8 (104). DOI: 10.3390/bs8110104
________________________________________________
2. Sivolap Iu.P., Damulin I.V. Sindrom Vernike–Korsakova. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2014; 4: 76–80 (in Russian).
3. Victor M, Adams RD, Collins GH. The Wernicke–Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with postmortem examinations. Contemp Neurol Ser 1971; 7: 1–206.
4. Grigor'eva V.N., Guzanova E.V., Mukhin V.V. Entsefalopatiia Vernike, tsentral'nyi pontinnyi mielinoliz, i polinevropatiia u bol'nykh s neukrotimoi rvotoi beremennykh (hyperemesis gravidarum). Nevrol. zhurn. 2016; 3: 131–41. DOI: 10.18821/1560-9545-2016-21-3-131-141 (in Russian).
5. Day GS, del Campo CM. Wernicke encephalopathy: a medical emergency. CMAJ 2014; 186 (8).
6. Lough ME. Wernicke’s encephalopathy: expanding the diagnostic toolbox. Neuropsychol Rev 2012; 22 (2): 181–94.
7. Chang HW, Yang PY, Han TI, Meng NH. Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery: a case report. Medicine (Baltimore) 2019; 98 (10): e14808. DOI: 10.1097/MD.0000000000014808
8. Nagarajan E, Rupareliya C, Bollu P. Wernicke’s encephalopathy as a rare complication of hyperemesis gravidarum: a case report and review of literature. Cureus 2018; 10 (5): e2597. DOI: 10.7759/cureus.2597
9. Talib V, Sultana S, Hamad A, Yaqoob U. Wernicke encephalopathy due to hyperemesis gravidarum in pregnancy: a case report. Cureus 2018; 10 (7): e2991. DOI: 10.7759/cureus.2991
10. Gungor Doğan İ, Uzun Altıokka G, Turker F et al. Wernicke’s encephalopathy due to non-alcoholic gastrointestinal tract disease. Arch Neuropsychiatry 2018; 55: 307–14.
11. Oudman E, Wijnia JW, van Dam M et al. Preventing Wernicke encephalopathy after bariatric surgery. Obesity Surgery 2018; 28: 2060–8.
12. Hamilton LA, Darby SH, Hamilton AJ et al. Case report of Wernicke's encephalopathy after sleeve gastrectomy. Nutr Clin Pract 2018; 33 (4): 510–4. DOI: 10.1177/0884533617722758
13. Tan TXZ, Lim KC, Chan Chung S, Aung T. Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy. BMJ Case Rep 2019; 12 (1).
14. Karakonstantis S, Galani D, Korela D et al. Missing the early signs of thiamine deficiency. A case associated with a liquid-only diet. Nutr Neurosci 2018; 1–3. DOI: 10.1080/1028415X.2018.1507964
15. Onishi H, Ishida M, Uchida N et al. Thiamine deficiency observed in a cancer patient's caregiver. Palliat Support Care 2019; 1–3. DOI: 10.1017/S1478951518001001
16. Oudman E, Wijnia JW, Oey MJ et al. Preventing Wernicke's encephalopathy in anorexia nervosa: a systematic review. Psychiatry Clin Neurosci 2018; 72 (10): 774–9. DOI: 10.1111/pcn.12735
17. Onishi H, Ishida M, Kagamu H et al. Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliat Support Care 2018; 1–3. DOI: 10.1017/S1478951518000469
18. Davies SB., Joshua FF., Zagami AS. Wernicke’s encephalopathy in a nonalcoholic patient with a normal blood thiamine level. Med J Aust 2011; 194 (9): 483–4.
19. Manzo G, De Gennaro A, Cozzolino A et al. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int 2014; 24: 503–96.
20. Latt N, Dore G. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Intern Med J 2014; 44 (9): 911–5. DOI: 10.1111/imj.12522
21. Abbas SA, Abboud H, Chalah MA et al. Isolated mammillary bodies damage – an atypical presentation of Wernicke syndrome. Behav Sci 2018; 8 (104). DOI: 10.3390/bs8110104
Авторы
А.В. Сердюк*1, Е.А. Ковражкина2, Н.Г. Абрамова3
1 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ФГБУ «Федеральный центр цереброваскулярной патологии и инсульта», Москва, Россия;
3 ГБУЗ «Городская клиническая больница №31», Москва, Россия
*aserdyuk@gmail.com
1 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ФГБУ «Федеральный центр цереброваскулярной патологии и инсульта», Москва, Россия;
3 ГБУЗ «Городская клиническая больница №31», Москва, Россия
*aserdyuk@gmail.com
________________________________________________
1 Pirogov Russian National Research Medical University, Moscow, Russia;
2 Federal Center for Cerebrovascular Disease and Stroke, Moscow, Russia;
3 City Clinical Hospital №31, Moscow, Russia
*aserdyuk@gmail.com
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