王尚尚　杨轩　张莹　陈振　张敬

非酒精性Wernicke脑病临床特点及MRI表现

王尚尚杨轩张莹陈振张敬

目的探讨非酒精性Wernicke脑病（WE）病人临床特点及MRI表现。方法回顾性分析经临床证实的10例非酒精性WE病人临床特点及MRI表现。结果胃肠道疾病所致反复呕吐、急性胰腺炎及妊娠剧烈呕吐为主要发病诱因。精神或意识改变为最常见临床表现。10例病人中仅1例为单发病灶，余9例均为多部位受累，病变部位包括双侧丘脑内侧及三脑室周围区（8例）、中脑导水管周围区（7例）、中脑顶盖（6例）、乳头体（4例）、四脑室底（4例）、小脑蚓部（1例）。所有病灶均于T2WI或T2FLAIR上呈对称性高信号。8例行DWI扫描，病灶呈高或稍高信号。1例行MRI增强检查，病灶呈轻度强化。4例于治疗后复查颅脑MRI，均见病灶缩小或消失。结论非酒精性WE的颅脑MRI表现具有特征性，结合病史及临床表现有助于做出早期诊断。

非酒精性Wernicke脑病；磁共振成像；维生素B1；代谢性脑病

DOI：10.19300/j.2016.L4052

【Abstract】ObjebtiveTo investigate the clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy（WE）.MethodsWe retrospectively reviewed clinical characteristics and MR imaging features of 10 patients with nonalcoholic WE.ResultsThe main predisposing factors included recurrent vomiting as a result of gastrointestinal disease，acute pancreatitis，and hyperemesis gravidarum.The most frequent neurologic finding was change in consciousness or mental status.On the MR images of the 10 patients，single area was involved in one cases，and multiple areas were involved in the remain 9 cases.The locations of lesions included the medial thalami and the periventricular region of the third ventricle （8 patients），the periaqueductal area（7 patients），the tectal plate（6 patients），the mamillary bodies（4 patients），the floor of forth ventricle（4 patients），and cerebellar vermis（1 patients）.The findings were symmetric hyperintensity on T2-weighted or fluidattenuated inversion recovery images in all lesions.Eight patients who underwent diffusion-weighted imaging demonstrated increased signal intensities in the affected areas.Contrast medium was administered in one patient，and the lesions showed slight enhancement.Four patients underwent follow-up MRI after therapy，all lesions shrunked or disappeared.Conclusion Nonalcoholic WE has characteristic MRI findings.Combining with clinical characteristics，MR features are useful in early diagnosis.

【Key words】Nonalcoholic wernicke encephalopathy；Magnetic resonance imaging；Vitamin B1；Metabolic encephalopathy

Int J Med Radiol，2016，39（2）：103-106

Wernicke脑病（Wernicke's encephalopathy，WE）是维生素B1缺乏引起的一种急性中枢神经系统代谢性脑病，临床上以意识或精神改变、眼部症状和小脑功能障碍“三联征”为主要表现。慢性酒精中毒是WE主要诱因，但胃肠外营养及营养不良等所致维生素B1缺乏也是重要诱因。由于非酒精性WE不具备典型“三联征”，临床上常被忽视，因而延误诊断和治疗。有研究［1］报道约20%非酒精性WE在尸检时才被确诊。非酒精性WE在MRI上具有一定特征性表现，有助于早期诊断，因此本文回顾性分析10例非酒精性WE的临床及影像资料，以提高对本病的认识，早期做出诊断。……