알코올 사용 장애 환자에서 동반되는 베르니케 뇌병증의 선별검사로서 티아민 혈중농도의 진단적 유용성

최동렬(Dongryeol Choi),정영철(Young-Chul Jung) 한국중독정신의학회 2017 중독정신의학 Vol.21 No.1

Objectives : The purpose of this study was to evaluate the utility in measuring the blood thiamine and thiamine pyrophosphate (TPP) levels as screening tests for Wernicke encephalopathy in patients with alcohol use disorder. Methods : We analyzed the demographic, clinical and laboratory data from 35 patients with alcohol use disorder. The blood thiamine and TPP levels were acquired at admission prior to initiation of thiamine intravenous (IV) therapy. We examined whether the blood thiamine and TPP levels correlated with clinical symptoms by apply-ing the Caine’s criteria. Patients who met at least one of Caine’s criteria were considered at high risk for Wernicke encephalopathy and were treated with high-dose thiamine IV therapy. Results : There was no correlation between blood thiamine/TPP levels and clinical symptoms of Wernicke encephalopathy. Clin-ical manifestations of the below-normal TPP-level group were not different from the normal TPP-level group, except that the normal TPP-level group showed a higher revised clinical insti-tute withdrawal assessment for alcohol (CIWA) scores. Conclusion : Measuring blood thiamine/TPP levels was not sensitive as screening tests for Wernicke encephalopathy among patients with alcohol use disorder. High-dose thiamine IV therapy improved the clinical symptoms of Wernicke encephalopathy in patients with alcohol use disorder. Objectives : The purpose of this study was to evaluate the utility in measuring the blood thiamine and thiamine pyrophosphate (TPP) levels as screening tests for Wernicke encephalopathy in patients with alcohol use disorder. Methods : We analyzed the demographic, clinical and laboratory data from 35 patients with alcohol use disorder. The blood thiamine and TPP levels were acquired at admission prior to initiation of thiamine intravenous (IV) therapy. We examined whether the blood thiamine and TPP levels correlated with clinical symptoms by apply-ing the Caine’s criteria. Patients who met at least one of Caine’s criteria were considered at high risk for Wernicke encephalopathy and were treated with high-dose thiamine IV therapy. Results : There was no correlation between blood thiamine/TPP levels and clinical symptoms of Wernicke encephalopathy. Clin-ical manifestations of the below-normal TPP-level group were not different from the normal TPP-level group, except that the normal TPP-level group showed a higher revised clinical insti-tute withdrawal assessment for alcohol (CIWA) scores. Conclusion : Measuring blood thiamine/TPP levels was not sensitive as screening tests for Wernicke encephalopathy among patients with alcohol use disorder. High-dose thiamine IV therapy improved the clinical symptoms of Wernicke encephalopathy in patients with alcohol use disorder.

베르니케뇌병증에 병발한 가역적 중증 연하장애-증례 보고-

최은석,목성균,조예림,민지혜,박영묵,김윤희,한지아 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.4

Wernicke's encephalopathy is a relatively underestimated disorder caused by a deficiency of thiamine and manifests with a classical triad of ocular abnormalities, ataxia, and mental-status changes. Specific laboratory tests are unavailable and the disease remains a clinical diagnosis. Among paraclinical studies, magnetic resonance imaging is currently considered the most valuable method to confirm a diagnosis of Wernicke's encephalopathy. Treatment is based on supplementation of thiamine that is administered parentally. We report a case of Wernicke's encephalopathy that was treated with thiamine and showed the characteristic clinical findings, as well as an extremely rare symptom of severe dysphagia that improved concurrently with neurological recovery. Only a few cases of dysphagia in Wernicke's encephalopathy have been reported worldwide.

임신입덧으로 발생한 베르니케 뇌병증 1예

이승현,이세진,이윤경,하정상,이준 영남대학교 의과대학 2004 Yeungnam University Journal of Medicine Vol.21 No.1

저자들은 임신 초기 산모에서 심한 임신입덧에 의해 발생된 베르니케 뇌병증 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Wernicke's encephalopathy is an acute-onset illness characterized by mental confusion, ataxia and ophthalmoplegia due to a thiamine deficiency. Immediate administration of thiamine prevents progression of the disease and reverses brain lesions. We have experienced a case of Wernicke's encephalopathy associated with hyperemesis gravidarum. As Wernicke's encephalopathy is mostly associated with chronic alcoholism, the possibility of Wernicke's encephalopathy may be ignored in young women. We emphasize the need for thiamine supplementation in the patient requiring intravenous alimentation such as hyperemesis gravidarum.

Wernicke’s encephalopathy following allogeneic hematopoietic stem cell transplantation

Yoon Ji Choi,Seh Jong Park,Jung Sun Kim,강은주,Byung Soo Kim,최철원 대한혈액학회 2010 Blood Research Vol.45 No.4

Wernicke’s encephalopathy is caused by thiamine deficiency, and is characterized by acute mental confusion, ataxia, and ophthalmoplegia. It is also a rare neurologic complication of hematopoietic stem cell transplantation (HSCT). However, because of its rare incidence, Wernicke’s encephalopathy can easily be overlooked in HSCT patients, and a few misleading steps in the early stage of the disease may result in permanent neurologic disability or even mortality. We recently encountered a case of Wernicke’s encephalopathy in a patient who underwent allogeneic HSCT. Based on our own experience and previously published documents, we suggest early radiologic surveillance and treatment for patients with findings compatible with Wernicke’s encephalopathy following HSCT.

다발성 골수종 환자에서 자가 조혈모세포 이식 중 장기간 비경구적 영양요법 후 발생한 베르니케 뇌증의 1례

이호섭 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

급성 백혈병, 림프종, 다발성 골수종을 포함한 다양한 혈액종양 질환을 치료하기 위한 최선의 방법은 조혈모세포 이식으로 알려져 있다. 그러나, 조혈모세포 이식에 따른 부작용들도 많은 것으로 알려져 있는데, 특히 오심, 구토, 설사, 구내염 등의 증상 때문에 식이 섭취의 부족으로 인해 영양 결핍이 초래될 수 있다. 그 중에서 비타민 B1 (thiamine) 의 결핍에 따른 베르니케 뇌증의 발생이 드물지만 있을 수 있다. 저자는 다발성 골수종 환자에서 자가조혈모세포 이식 시행후 발생한 베르니케 뇌증의 1 례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Wernicke’s encephalopathy is an acute neurologic disease which results from vitamin B1 (thiamin) deficiency. Clinical symptoms are ataxia, opthalmoplegia and mental change. This disease affects the thalamus, midbrain and mammillary bodies. The diagnosis of Wernicke’s encephalopathy is made with brain Magnetic resonance imaging (MRI) and its clinical symptoms. but The confirming test is not known as yet. Most common causes of this disease are chronic alcoholism, total parenteral nutrition, total gastrectomy, and severe anorexia but rare cases reported about occurrence of Wernicke’s encephalopathy after chemotherapy or hematopoietic stem cell transplantation. An author present a case of Wernicke’s encephalopathy developed after autologous stem cell transplantation followed by total parenteral nutrition in a patient with multiple myeloma.

급성 골수성 백혈병 환자에서 관해 유도 항암 화학요법 후 발생한 베르니케 뇌증

황진원,정재현,서광원,최병진,송영진,김종윤,이은지,임홍규,이상민 인제대학교 2009 仁濟醫學 Vol.30 No.-

Wernicke's encephalopathy is characterized by the triad of ocular symptoms, ataxia, and mental confusion and neuropsychiatric condition generally caused by acute thiamine deficiency. Although it is common in the severe alcoholics, several other causes also have been identified, such as total parenteral nutrition (TPN) use, hyperemesis gravidarum, anorexia nervosa, hemodialysis, uremia, and acquired immunodeficiency syndrome(AIDS). Chemotherapy in patient with malignanacy and long term total parenteral nutrition following bone marrow transplantation are related with Wernicke's encephalopathy. A 48-year-old woman had been treated with Daunorubicin and Cytarabine for remission induction chemotherapy of acute myeloblastic leukemia and intravenous hyperalimentation due to persistent hematochezia and ileus caused by infiltration of leukemic cell in terminal ileum. She suddenly complained of diplopia, tremor, and mental confusion at 32th day after chemotherapy and generalized tonic-clonic seizure at 34th day after chemotherapy. The diagnosis of Wernicke's encephalopathy was made with clinical presentations and brain MRI. Brain MR T2-weighted & Flair image revealed a high signal intensity lesions bilaterally at the medial thalamus and peri-acueductal grey matter of the midbrain. The patient was successfully treated with vitamin B1. We presented a case of acute Wernicke's encephalopathy developed after remission induction chemotherapy followed by intravenous hyperalirnentation in a patient with acute myeloblastic leukemia.

한의치료로 호전되었던 사지마비, 운동실조, 인지저하를 호소하는 베르니케 뇌병증 환자 증례보고 1례

심상송,이현승,안재윤,채한나,윤종민,문병순 대한한방내과학회 2020 大韓韓方內科學會誌 Vol.41 No.5

Background: This study is a report on a case of a Wernicke’s encephalopathy with quadriplegia, ataxia, and impaired cognition, whose condition was improved by Korean medicine treatment. Case report: A 51-year-old man diagnosed with Wernicke’s encephalopathy was treated with acupuncture, Banhabakchulchunma-tang mixed with Ondam-tang-gami (半夏白朮天麻湯合溫膽湯加味), cupping, moxibustion, and rehabilitation. Clinical symptoms were measured with the Manual Muscle Test (MMT), Berg Balance Scale (BBS), Korean Mini Mental Status Exam (K-MMSE), Functional Independence Measure (FIM), Modified Barthel Index (MBI), and a numeric rating scale (NRS). After 22 days of treatment, his clinical symptoms showed improvement. The motor function improved (MMT Rt. side Gr. 4+G/4+G, Lt. side Gr. 4G/4+G → Rt. side Gr. 5-N/4+G, Lt. side Gr. 5-N/4+G), Ataxia was relieved (BBS 3→33), cognition improved (K-MMSE 15→27), ADL scores showed improvement (FIM 58→90, MBI 40→75), and the NRS score decreased for headache (3→0). Conclusion: Korean medicine treatment could be effective in the treatment of patients with Wernicke’s encephalopathy.

급성 알코올성 췌장염 환자에서 발병한 베르니케 뇌병증 1예

안지현 ( Ji Hyun Ahn ),김정욱 ( Jeong Wook Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6

베르니케 뇌병증은 티아민 부족으로 인한 급성 정신혼돈, 조화운동못함증, 눈근육마비롤 보이는신경 질환이다. 대부분 알코올 중독자에서 관찰되나 영양실조나 비타민의 적절한 공급이 동반되지 않은 장기간의 정맥영양에서도 관찰된다. 저자들은 알코올중독자에서 발생한 급성 알코올성 췌장염 환자에서 동반된 베르니케 뇌병증을 경험하여 보고한다. 환자는 3주간 금식과 간헐적인 비타민 공급을 포함한 정맥영양투여를 받았다. 금식 후 고탄수화물식을 섭취를 시작한 뒤부터 겹보임, 지남력 장애, 착란, 보행 장애와 안구진탕이 나타났다. 베르니케 뇌병증으로 진단하고 티아민을 정맥투여한 후에 증상이 소실되었다. Wernicke`s encephalopathy is a serious neurological disorder caused by thiamine deficiency that is characterized by the triad of ocular abnormalities, ataxia, and global confusional state. It is most often seen in alcoholics, but it can be seen in disorders associated with malnutrition and with prolonged intravenous feeding without appropriate vitamin supplementation. We report the case of a 51-year-old man with acute alcoholic pancreatitis and chronic alcoholism with an intraperitoneal abscess, who presented with Wernicke`s encephalopathy. He was initially treated by fasting, intravenous fluid replacement, and intermittent vitamin infusion for 3 weeks. After subsequently starting a high carbohydrate oral diet, the patient developed diplopia, orientation disturbance, ataxia, a confusional state, and nystagmus. His neurologic signs and symptoms normalized gradually after intravenous thiamine supplementation. (Korean J Med 75:700-703, 2008)

Wernicke's Encephalopathy in Non-alcholics

Lee, Kwang-Hoon,Lee, Jong-Geol,Han, Seol-Heui 충북대학교 의과대학 충북대학교 의학연구소 1997 忠北醫大學術誌 Vol.7 No.2

베르니케뇌증은 주로 알콜중독 환자에서 발생하며 의식장애, 보행실조, 안운동장애를 세가지주 증상으로 발현하는 급성 뇌질환이다. 초기 단계에 적절한 치료를 하지 못할 경우 치사율이 17%에 달하며 심각한 신경학적 결손이 발생하는 응급질환이다. 저자들은 알콜중독이 아닌 환자에서 전형적인 임상 양상과 핵자기 공명 영상으로 진단된 베르니케뇌증 2 예를 경험하였기에 보고하고자 한다. We report on two patients with Wernicke's encephalopathy of unusual etiologies. The first patient was a non-alcoholic 45-year-old woman who had fasted fort fortnight for religious reason. She had been vomiting for several days and treated with IV dextrose without vitamin supplementation. She became lethargic and mentally confused when referred to our hospital. She gradually improved after administration of large dose of thiamine but she left with major impairment to her short-term memory. T2-weighted brain MRI resealed hyperintense lesions around the third ventricle and aqueduct and medial thalami. The second patient was a 26-year-old woman who was 6 weeks pregnant. She had been a known thyrotoxic patient but well before developing hyperemesis gravidarum. She had been vomiting and fasting fort 4 weeks, hence she was treated with IV glucose elsewhere. She became stuporous when referred to our clinic. Neurologic examination revealed complete ophthalmoplegia in a semicomatose woman. Her brain MRI showed mammilary atrophy, abnormal signals in the periaqueductal area and medial thalami. We propose that in any clinical settings of neurological symptoms such as consciousness disturbances, abnormal eye movements, ataxia associated with prolonged fasting and/or vomiting, the possibility of Wernicke's encephalopathy should always be taken into consideration even in non-alcoholics, and thiamine should be immediately administered to reduce the risk of serious neurologic sequelae.

대뇌피질을 광범위하게 침범한 비알코올성 베르니케뇌병증

성원재,박성호,정윤철,한석길,김현영,김희태,김주한,김영서 대한신경과학회 2016 대한신경과학회지 Vol.34 No.3

Wernicke’s encephalopathy is an acute neurological deterioration due to a reversible brain lesion caused by thiamine deficiency. Most of the affected patients are thiamine-depleted alcoholics, and the condition usually involves the medial thalami, mammillary bodies, and periaqueductal area. However, there are rare reports of lesions in the cerebellum and cerebral cortex, especially in patients with nonalcoholic Wernicke’s encephalopathy. We report a case of nonalcoholic Wernicke’s encephalopathy involving atypical diffuse cortical regions, and review previously reported cases.