非酒精性Wernicke腦病臨床特點及MRI表現(xiàn)

王尚尚　楊軒　張瑩　陳振　張敬

非酒精性Wernicke腦病臨床特點及MRI表現(xiàn)

王尚尚楊軒張瑩陳振張敬

目的探討非酒精性Wernicke腦?。╓E）病人臨床特點及MRI表現(xiàn)。方法回顧性分析經臨床證實的10例非酒精性WE病人臨床特點及MRI表現(xiàn)。結果胃腸道疾病所致反復嘔吐、急性胰腺炎及妊娠劇烈嘔吐為主要發(fā)病誘因。精神或意識改變?yōu)樽畛Ｒ娕R床表現(xiàn)。10例病人中僅1例為單發(fā)病灶，余9例均為多部位受累，病變部位包括雙側丘腦內側及三腦室周圍區(qū)（8例）、中腦導水管周圍區(qū)（7例）、中腦頂蓋（6例）、乳頭體（4例）、四腦室底（4例）、小腦蚓部（1例）。所有病灶均于T2WI或T2FLAIR上呈對稱性高信號。8例行DWI掃描，病灶呈高或稍高信號。1例行MRI增強檢查，病灶呈輕度強化。4例于治療后復查顱腦MRI，均見病灶縮小或消失。結論非酒精性WE的顱腦MRI表現(xiàn)具有特征性，結合病史及臨床表現(xiàn)有助于做出早期診斷。

非酒精性Wernicke腦病；磁共振成像；維生素B1；代謝性腦病

DOI：10.19300/j.2016.L4052

【Abstract】ObjebtiveTo investigate the clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy（WE）.MethodsWe retrospectively reviewed clinical characteristics and MR imaging features of 10 patients with nonalcoholic WE.ResultsThe main predisposing factors included recurrent vomiting as a result of gastrointestinal disease，acute pancreatitis，and hyperemesis gravidarum.The most frequent neurologic finding was change in consciousness or mental status.On the MR images of the 10 patients，single area was involved in one cases，and multiple areas were involved in the remain 9 cases.The locations of lesions included the medial thalami and the periventricular region of the third ventricle （8 patients），the periaqueductal area（7 patients），the tectal plate（6 patients），the mamillary bodies（4 patients），the floor of forth ventricle（4 patients），and cerebellar vermis（1 patients）.The findings were symmetric hyperintensity on T2-weighted or fluidattenuated inversion recovery images in all lesions.Eight patients who underwent diffusion-weighted imaging demonstrated increased signal intensities in the affected areas.Contrast medium was administered in one patient，and the lesions showed slight enhancement.Four patients underwent follow-up MRI after therapy，all lesions shrunked or disappeared.Conclusion Nonalcoholic WE has characteristic MRI findings.Combining with clinical characteristics，MR features are useful in early diagnosis.

【Key words】Nonalcoholic wernicke encephalopathy；Magnetic resonance imaging；Vitamin B1；Metabolic encephalopathy

Int J Med Radiol，2016，39（2）：103-106

Wernicke腦病（Wernicke's encephalopathy，WE）是維生素B1缺乏引起的一種急性中樞神經系統(tǒng)代謝性腦病，臨床上以意識或精神改變、眼部癥狀和小腦功能障礙“三聯(lián)征”為主要表現(xiàn)。慢性酒精中毒是WE主要誘因，但胃腸外營養(yǎng)及營養(yǎng)不良等所致維生素B1缺乏也是重要誘因。由于非酒精性WE不具備典型“三聯(lián)征”，臨床上常被忽視，因而延誤診斷和治療。有研究［1］報道約20%非酒精性WE在尸檢時才被確診。非酒精性WE在MRI上具有一定特征性表現(xiàn)，有助于早期診斷，因此本文回顧性分析10例非酒精性WE的臨床及影像資料，以提高對本病的認識，早期做出診斷。……