Wernicke encephalopathy
小结
定义
病史和体格检查
关键诊断因素
- history of gastrointestinal (GI) surgery
- mental slowing, confusion, impaired concentration, and apathy
- oculomotor signs
- history of alcohol-use disorder
- pre-existing conditions that predispose to malnutrition: for example, HIV/AIDS, cancer, anorexia/bulimia, prolonged vomiting, or diarrhea
- classic triad: mental status changes, ophthalmoplegia, and gait dysfunction
其他诊断因素
- mild irritability
- acute psychosis
- coma
- miosis, anisocoria, light/near dissociation
- papilledema, retinal hemorrhages
- tachycardia or hypotension
- hypothermia or hyperthermia
- hearing loss, epileptic seizures, and spastic paraparesis
- ataxia
危险因素
- alcohol-use disorder
- HIV infection and AIDS
- cancer and treatment with chemotherapeutic agents
- malnutrition
- history of gastrointestinal (GI) surgery
- genetic variants associated with altered thiamine metabolism and transport
- bone marrow transplantation
- male sex
诊断性检查
首要检查
- therapeutic trial of parenteral thiamine
- serum thiamine
- MRI of brain
- blood glucose
- CBC
- serum electrolytes
- renal function
- LFTs
- toxicology screen
- serum ammonia
- blood alcohol level
需考虑的检查
- lumbar puncture
治疗流程
suspected Wernicke encephalopathy
high risk for thiamine deficiency
撰稿人
作者
Gregory S. Day, MD, MSc, MSCI, FAAN, FANA, FANA
Associate Professor of Neurology
Division Director, Behavioural Neurology
Mayo Clinic in Florida
Jacksonville
FL
利益声明
GSD declares no competing interests directly relevant to this work. His research is supported by the National Institute of Health (U01AG057195, U01NS120901, U19AG032438). He serves as a consultant for Parabon NanoLabs, Inc. and as a topic editor (Dementia) for DynaMed (EBSCO). He is the co-project principal investigator for a clinical trial in anti-NMDAR encephalitis, which receives support from the National Institute of Neurological Disorders and Stroke (U01NS120901) and Amgen Pharmaceuticals, and a consultant for Arialys Therapeutics. He has developed and edited educational materials for Continuing Education, Inc. and Ionis Pharmaceuticals. GDS owns stock in ANI Pharmaceuticals. His institution has received support from Eli Lilly and Company for development and participation in an educational event promoting early diagnosis of symptomatic Alzheimer disease, and in-kind contributions of radiotracer precursors for tau-PET neuroimaging in studies of memory and aging (via Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly and Company).
鸣谢
Dr Gregory S. Day would like to gratefully acknowledge Dr Abhay Moghekar, a previous contributor to this topic. AM is a medical advisory board member of the Hydrocephalus Association and was reimbursed for travel and airfare. AM was a consultant to Quest Diagnostics and Orbees Incorporation for market research, receiving payment for consulting. AM undertook research for Fujirebio Diagnostics and received a research grant to his lab at Johns Hopkins University.
同行评议者
Adrian Priesol, MD, FRCPC
Instructor
Massachusetts Eye and Ear Infirmary
Harvard Medical School
Boston
MA
利益声明
AP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Galvin R, Bråthen G, Ivashynka A, et al. Guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010 Dec;17(12):1408-18.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Alcohol intoxication
- Alcohol withdrawal
- Viral encephalitis
更多 鉴别诊断指南
- Guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy
更多 指南
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明