Alcoholic Korsakoff's Syndrome: An Update
Alcoholic Korsakoff's Syndrome: An Update
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酒精性柯萨可夫综合症：更新
DOI：
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
N. Butters
中科院分区：
文献类型：
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作者：
N. Butters
188 1，卡尔·韦尼克 (Carl Wernicke) 描述了三名患者（两名男性酗酒者和一名硫酸中毒女性）的神经系统综合征，包括共济失调、视神经异常和精神错乱状态。这三名患者的尸检显示，大脑第三脑室和第四脑室周围的灰质对称地出现小点状出血。韦尼克将这种现在以他的名字命名的疾病描述为一种动眼神经核的急性炎症性疾病，并指出症状是进行性的，并在大约两周内导致死亡。韦尼克的论文发表六年后，S.S. Korsakoff 发表了一系列报告中的第一篇，其中详细描述了经常伴随多发性神经病疾病的遗忘和虚构症状。尽管长期酗酒往往先于这些精神变化，但科萨科夫指出，这些症状也会伴随其他一些情况出现，例如持续呕吐、伤寒和肠梗阻。根据他的观察，他得出结论，对周围和中枢神经系统有毒的物质的存在一定是他报告的病例的共同点。尽管韦尼克和科萨科夫都无法明确病因，而且两人似乎都没有意识到他们的两种综合征经常在同一患者身上相继发生，但他们对患者症状的临床描述是准确的，代表了识别和理解韦尼克-科萨科夫综合征的重要初始步骤。韦尼克阶段的主要症状包括全身性混乱状态、眼肌麻痹、眼球震颤、共济失调以及腿部和手臂的多发性神经病（疼痛、感觉丧失、无力）。在这些神经系统症状中，整体混乱状态可能与我们的利益最密切相关。患者对时间和地点感到迷失方向，无法认出熟悉的人，冷漠、注意力不集中，最重要的是，无法保持连贯的对话。如果韦尼克脑病患者没有接受大剂量的硫胺素治疗，他就有发生致命性中脑出血的危险。如果。然而，患者确实接受适当的维生素治疗，神经症状会明显改善。在大多数情况下，眼部问题几乎会消失，共济失调和周围神经病变会改善，混乱状态也会消失。也就是说，经过2或3周的硫胺素治疗后，患者将意识到自己在医院，认出自己的妻子和孩子，并能够与医生保持清晰的对话。此时，该患者已过了急性韦尼克期，进入慢性科萨科夫期。很少有 Wernicke 患者（约 25%）表现出完全恢复到病前智力状态。
In 188 1, Carl Wernicke described in three patients (two male alcoholics and one woman with sulfuric acid poisoning) a neurologic syndrome that included ataxia, optic abnormalities, and a confusional state. Postmortem examination of these three patients showed small punctate hemorrhages symmetrically located in the gray matter around the third and fourth ventricles of the brains. Wernicke characterized this disorder, which now bears his name, as an acute inflammatory disease of the oculomotor nuclei and noted that the symptoms were progressive and led to death in approximately 2 weeks. Six years following the publication of Wernicke's paper, S.S. Korsakoff published the first of a series of reports in which he detailed the amnesic and confabulatory symptoms that often accompanied disorders involving polyneuropathy. Although long-term alcoholism often preceded these mental changes, Korsakoff noted that the symptoms also followed a number of other conditions, such as persistent vomiting, typhoid fever, and intestinal obstruction. On the basis of his observations, he concluded that the presence of a substance toxic to the peripheral and central nervous systems must have been the common denominator in his reported cases. Although neither Wernicke nor Korsakoff could be specific with regard to etiology, and both seemed unaware that their two syndromes often occurred sequentially in the same patients, their clinical descriptions of their patients' symptomatology were accurate and represented important initial steps in the identification and understanding of the Wernicke-Korsakoff syndrome. The major symptoms of the Wernicke stage include a global confusional state, ophthalmoplegia, nystagmus, ataxia, and polyneuropathy (pain, loss of sensation, weakness) of the legs and arms.' Of these neurologic symptoms, the global confusional state is perhaps most germane to our interests. The patient is disoriented with regard to time and place, is unable to recognize familiar people, i> apathetic, inattentive, and, most significant, is unable to maintain a coherent conversation. If a patient with Wernicke's encephalopathy is not treated with large doses of thiamine, he is in danger of having fatal midbrain hemorrhages. If. however, the patient does receive proper vitamin therapy, the neurologic symptoms will improve markedly. In most cases, the ocular problems will almost disappear, the ataxia and peripheral neuropathies will improve, and the confusional state will clear. That is, after 2 or 3 weeks of thiamine treatment, the patient will realize that he is in a hospital, recognize his wife and children, and be able to maintain an intelligible conversation with his physician. At this point, that patient has passed the acute Wernicke phase and has entered the chronic Korsakoff stage. Few Wernicke patients (about 25%) show a complete recovery to their premorbid intellectual state.'
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影响因子：
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DOI：
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DOI：
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影响因子：
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