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Encefalopatia de Wernicke

Última revisão: 5 Oct 2024
Última atualização: 17 Sep 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • história de cirurgia gastrointestinal
  • lentidão mental, confusão, deficiência de concentração e apatia
  • sinais oculomotores
  • história de transtornos decorrentes do uso de bebidas alcoólicas
  • condições preexistentes que predispõem à desnutrição: por exemplo, HIV/AIDS, câncer, anorexia/bulimia, vômitos prolongados ou diarreia
  • tríade clássica: alterações no estado mental, oftalmoplegia e disfunção da marcha
Detalhes completos

Outros fatores diagnósticos

  • irritabilidade leve
  • psicose aguda
  • coma
  • miose, anisocoria, dissociação luz-perto
  • papiledema, hemorragias retinianas
  • taquicardia ou hipotensão
  • hipotermia ou hipertermia
  • perda auditiva, crises epilépticas e paraparesia espástica
  • ataxia
Detalhes completos

Fatores de risco

  • transtornos decorrentes do uso de bebidas alcoólicas
  • Infecção por HIV e AIDS
  • câncer e tratamento com agentes quimioterápicos
  • desnutrição
  • história de cirurgia gastrointestinal
  • variantes genéticas associadas ao metabolismo e transporte alterados da tiamina
  • transplante de medula óssea
  • sexo masculino
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • tentativa terapêutica de tiamina parenteral
  • tiamina sérica
  • ressonância nuclear magnética (RNM) cranioencefálica
  • glicose sanguínea
  • Hemograma completo
  • eletrólitos séricos
  • função renal
  • TFHs
  • análise toxicológica
  • amônia sérica
  • nível de álcool no sangue
Detalhes completos

Investigações a serem consideradas

  • punção lombar
Detalhes completos

Algoritmo de tratamento

Aguda

suspeita de encefalopatia de Wernicke

Contínua

alto risco de deficiência de tiamina

Colaboradores

Autores

Gregory S. Day, MD, MSc, MSCI, FAAN, FANA, FANA

Associate Professor of Neurology

Division Director, Behavioural Neurology

Mayo Clinic in Florida

Jacksonville

FL

Declarações

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's 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).

Agradecimentos

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.

Revisores

Adrian Priesol, MD, FRCPC

Instructor

Massachusetts Eye and Ear Infirmary

Harvard Medical School

Boston

MA

Declarações

AP declares that he has no competing interests.

  • Encefalopatia de Wernicke images
  • Diagnósticos diferenciais

    • Intoxicação alcoólica
    • Abstinência alcoólica
    • Encefalite viral
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  • Diretrizes

    • Alcohol-use disorders: diagnosis and management of physical complications
    • Guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy
    Mais Diretrizes
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