Wernicke's encephalopathy in patients on peritoneal dialysis or hemodialysis
Wernicke's encephalopathy in patients on peritoneal dialysis or hemodialysis
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腹膜透析或血液透析患者的韦尼克脑病
DOI：
10.1002/ana.410210114
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发表时间：
1987
影响因子：
11.2
通讯作者：
M. F. H. S. Smyth
中科院分区：
文献类型：
--
作者：
MD Venkita Jagadha;M. F. John H. N. Deck;M. F. William C. Halliday;M. F. H. S. Smyth
虽然经常提到透析患者发生韦尼克脑病（WE），但文献综述显示仅描述了3例病例。我们描述了5例透析患者，他们在没有酒精中毒或其他诱发因素的情况下发展为WE。临床诊断包括尿毒症脑病（2例）、平衡障碍综合征（1例）、透析性痴呆（1例）和脑干出血（1例）。在尸检中，WE的典型发现是明显的。在透析患者中WE的罕见性可能部分由转酮醇酶活性的遗传缺陷的研究来解释。由于厌食、呕吐和静脉营养，透析患者也有可能出现硫胺素缺乏症。其他改变硫胺素需求的因素，如葡萄糖负荷或感染，也可能起作用。由于WE是可治愈的，且可能治愈，因此在所有透析患者中，如果出现无法解释的神经系统症状，则应怀疑WE。
Although the occurrence of Wernicke's encephalopathy (WE) in patients on dialysis is frequently alluded to, review of the literature reveals only 3 described cases. We describe 5 patients on dialysis who developed WE in the absence of alcoholism or other predisposing factors. The clinical diagnoses included uremic encephalopathy (2 patients), dysequilibrium syndrome (1), dialysis dementia (1), and brainstem hemorrhage (1). At postmortem examination, classic findings of WE were evident. The rarity of WE in patients on dialysis may in part be explained by studies indicating a genetic defect in transketolase activity. Patients on dialysis are also potentially at risk for thiamine deficiency because of anorexia, vomiting, and intravenous alimentation. Other factors altering thiamine requirements, such as glucose load or infections, may also contribute. Preventable and potentially curable, WE should be suspected in all patients on dialysis who have an unexplained neurological picture.