非酒精中毒性韦尼克脑病的临床与MRI特征  

Clinical and MRI Features of Nonalcoholic Wernicke's Encephalopathy

作　　者：费国强[1] 钟春玖[1] 金莉蓉[1] 王坚[2] 张宇浩[1] 郑小敏[1] 张昱雯[1] 洪震[2] 

机构地区：[1]复旦大学附属中山医院神经内科,上海市医学院路136号200032 [2]复旦大学附属华山医院神经内科,上海市医学院路136号200032

出　　处：《中国医学计算机成像杂志》2008年第1期11-16,共6页Chinese Computed Medical Imaging

摘　　要：目的:提高对非酒精中毒性韦尼克脑病的认识、早期诊断率及预后判断能力。材料和方法:对我院1999～2006年收治的12例非酒精中毒性韦尼克脑病患者临床特征、颅脑磁共振成像特点及治疗转归进行分析。结果:非酒精中毒性韦尼克脑病患者临床表现复杂,大多病例缺乏特征性临床表现。颅脑MRI检查显示韦尼克脑病患者疾病严重程度、临床预后和转归与其脑部组织损害范围相关,其典型主要表现为内侧丘脑、第四脑室底部及侧脑室、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,深昏迷患者出现大脑皮质损害。乳头体萎缩少见,增强可见强化。深昏迷及大脑皮质受损的患者预后不佳,其余患者及时给予维生素B1治疗,预后良好。结论:大多非酒精中毒性韦尼克脑病缺乏特征性临床表现,颅脑MRI有一定特异性,具有诊断和预后判断价值。Purpose： In order to pay more attention to nonalcoholic Wernicke＇ s encephalopathy and to improve the rates of earlier diagnosis and the judgment of prognosis. Materials and Methods： A retrospective review was conducted on 12 cases of nonalcoholic Wernicke＇s encephalopathy from 1999 to 2006 at Zhongshan hospital , which was consisted of clinical and cranial MRI features and the analyses of prognosis after the administration of thiamine.Results： Clinical manifestations of nonalcoholic Wernicke＇ s encephalopathy were complicated and most of them had no specific value for diagnosis. Cranial MR and FLAIR imaging exhibited the correlation between the severity and prognosis of the disease and the damage area of the brain. Typical MRI features showed that increased T2W and FLAIR signal symmetrically surrounding the aqueduct and third ventricle, at the floor of fourth ventricle, and within the medial thalamus. In the patients with deep coma, the increased T2W and FLAIR signals were found in the regions of cortex. The signal of mammillary bodies of 2/3 patients were enhanced with contrast medium. However, the atrophy of mammillary bodies was not found. Cortex damage may be indicative of irreversible damage and poor prognosis. Conclusion： Nonalcoholic Wernicke＇s encephalopathy lacks characteristic clinical manifestation and is easy to be misdiagnosed. Cranial MR has great value to diagnose Wernicke＇ s encephalopathy and to judge the prognosis of this disease.

关 键 词：韦尼克脑病 维生素B1 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R747.9[医药卫生—诊断学]