非酒精中毒性韦尼克脑病的诊断与误诊原因分析  

Clinical Diagnosis and Misdiagnosis Analysis of Nonalcoholic Wernicke's Encephalopathy

作　　者：钟春玖[1] 费国强[1] 金莉蓉[1] 汪昕[1] 朱文炳[1] 

机构地区：[1]复旦大学附属中山医院神经内科,上海200032

出　　处：《中国临床医学》2004年第5期693-695,共3页Chinese Journal of Clinical Medicine

摘　　要：目的 :提高对非酒精中毒性韦尼克脑病的认识及早期临床诊断率 ,减少临床误诊。方法 :对我院 2 0 0 0～ 2 0 0 3年收治的 6例非酒精中毒性韦尼克脑病患者临床特征、颅脑核磁共振成像特点及临床诊断与误诊、治疗转归进行分析。结果 :6例患者中出现神经系统临床症候、及时拟诊为非酒精中毒性韦尼克脑病的仅 3例 ,其余 3例均有不同程度的误诊。患者早期临床表现为头晕、嗜睡、表情淡漠、记忆障碍、共济失调、眼球震颤与眼球运动障碍的不同组合 ,缺乏特征性 ;典型表现与文献报道的酒精中毒性韦尼克脑病一致 ,即为共济失调、眼球运动障碍与记忆、意识障碍等。颅脑核磁共振及其Flair成像检查显示其主要表现为内侧丘脑及侧脑室、第三脑室、中脑导水管周围等脑组织对称性T2加权及Flair异常高信号 ,1例成为持续性植物状态的患者伴有广泛皮层T2加权及Flair异常高信号。 4例临床康复患者的颅脑核磁共振及其Flair成像随访显示 ,其异常信号随临床表现好转而逐渐消失 ;1例持续性植物状态患者随访 2年 ,颅脑异常信号无变化。经维生素B1补充治疗后 1例死亡 ,1例成为持续性植物状态 ,另 4例分别在治疗 2周～ 1年后完全恢复正常。结论 :非酒精中毒性韦尼克脑病患者早期缺乏特征性临床表现 ,易被临床误诊 ,颅脑MRI及其Flair?Objective: In order to pay enough attention to nonalcoholic Wernicke's encephalopathy, have early recognition and reduce the misdiagnosis. Methods: A retrospective review was conducted of all six cases of nonalcoholic Wernicke's encephalopathy from 2000 to 2003 at Zhongshan hospital, consisted of clinical character and diagnostic criteria, cranial MRI features, analyses of misdiagnosis and outcomes after the administration of thiamine. Results: Only 3/6 patients with nonalcoholic Wernicke's encephalopathy were diagnosed promptly and 3/6 patients were misdiagnosed. Early manifestations of nonalcoholic Wernicke's encephalopathy lacked diagnostic characteristic, including dizziness, drowsiness, emotional apathy, memory retention, ataxia, nystagmus, ocular movement disorder and so forth. Classic features, namely triad of ocular abnormalities, ataxia and global confusion, were coincident between nonalcoholic and alcoholic Wernicke's encephalopathy. Cranial MR and Flair imaging of the patients exhibited areas of increased T2W and flair signal symmetrically surrounding the aqueduct and third ventricle and within the medial thalamus. The patient who became persistent vegetative state coexistenced increased T2W and flair signal of the cortex. There were 1/6 patient died and 1/6 patient became persistent vegetative state and others recovered fully from two weeks to one year after administration of vitamin B_1. Conclusion:Earlier period of Nonalcoholic Wernicke's encephalopathy lacks characteristic clinical manifestation and is easy to be misdiagnosed. Cranial MR and Flair imaging have great value to diagnose Wernicke's encephalopathy.

关 键 词：韦尼克脑病 患者 酒精中毒 颅脑 毒性 诊断 持续性植物状态 特征 价值 表现 

分 类 号：R742[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]