Acute Wernicke's Encephalopathy following Bariatric Surgery: Clinical Course and MRI Correlation
Acute Wernicke's Encephalopathy following Bariatric Surgery: Clinical Course and MRI Correlation
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减肥手术后急性韦尼克脑病：临床过程和 MRI 相关性
DOI：
10.1381/096089204772787437
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发表时间：
2004
期刊：
影响因子：
2.9
通讯作者：
Robert J. Labutta
中科院分区：
文献类型：
--
作者：
Y. Loh;W. D. Watson;A. Verma;S. Chang;D. Stocker;Robert J. Labutta
减肥手术引起的术后并发症和营养缺乏可导致严重的维生素缺乏状态，如韦尼克脑病（WE）。急性WE患者通常表现为注意力不集中、共济失调和眼肌麻痹的典型临床三联征。我们描述了一个病人谁提出了急性WE在2个月后腹腔镜减肥手术。最初的脑部MRI显示了WE的特征性损伤，重复成像显示在补充硫胺素4个月后消退，此时患者步态正常，但记忆力持续下降。即使早期识别和积极治疗，急性WE通常会导致永久性残疾，这是由于对大脑特定区域的不可逆细胞毒性作用。由于急性WE的临床发作在减肥手术后营养不良患者中遵循可预测的时间过程，我们建议营养不良患者从术后6周开始注射肠外硫胺素进行预防。
Postoperative complications and nutritional deficits resulting from bariatric surgery can lead to severe vitamin-deficiency states, such as Wernicke's encephalopathy (WE). Patients with acute WE generally present with the classic clinical triad of inattentiveness, ataxia, and ophthalmoplegia. We describe a patient who presented with acute WE at 2 months after laparoscopic bariatric surgery. Initial MRI of the brain demonstrated the characteristic injuries of WE, and repeat imaging showed resolution after 4 months of thiamine supplementation, at which time the patient had normal gait but persistent memory deficits. Even with early recognition and aggressive therapy, acute WE commonly results in permanent disability due to the irreversible cytotoxic effects on specific regions of the brain. Since the clinical onset of acute WE follows a predictable time-course in postbariatric surgery patients with malnutrition, we recommend prevention by administration of parenteral thiamine beginning at 6 weeks postoperatively in malnourished patients.