EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy
Tóm tắt
The clinical diagnosis of WE should take into account the different presentations of clinical signs between alcoholics and non alcoholics (Recommendation Level C); although prevalence is higher in alcoholics, WE should be suspected in all clinical conditions which could lead to thiamine deficiency (good practice point – GPP). The clinical diagnosis of WE in alcoholics requires two of the following four signs; (i) dietary deficiencies (ii) eye signs, (iii) cerebellar dysfunction, and (iv) either an altered mental state or mild memory impairment (Level B). Total thiamine in blood sample should be measured immediately before its administration (GPP). MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B). Thiamine is indicated for the treatment of suspected or manifest WE. It should be given, before any carbohydrate, 200 mg thrice daily, preferably intravenously (Level C). The overall safety of thiamine is very good (Level B). After bariatric surgery we recommend follow‐up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation (GPP). Parenteral thiamine should be given to all at‐risk subjects admitted to the Emergency Room (GPP). Patients dying from symptoms suggesting WE should have an autopsy (GPP).
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Tài liệu tham khảo
WernickeC.Lehrbuch der Gehirnkrankheiten fur Aerzte und Studirende.1881;229–242.
Thomson AD, 1983, Ethanol, thiamine and brain damage, Alcohol Alcohol, 18, 27
Brown LM, 1983, Efficacy of vitamin supplementation in chronic alcoholics undergoing detoxification, Alcohol Alcohol, 18, 157
Jellinger K, 1976, Neuropathological aspects of dementias resulting from abnormal blood and cerebrospinal fluid dynamics, Acta Neurol Belg, 76, 83
Victor M, 1971, The Wernicke‐Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post‐mortem examinations, Contemp Neurol Ser, 7, 1
Pollak KH, 1989, Alcoholism and morphologic findings of the nervous system in autopsy cases, Psychiatr Neurol Med Psychol (Leipz), 41, 664
Riethdorf L, 1991, Die Alkoholenzephalopathien im Obduktionsgut, Zentralbl Pathol, 137, 48
Boldorini R, 1992, Wernicke’s encephalopathy: occurrence and pathological aspects in a series of 400 AIDS patients, Acta Biomed Ateneo Parmense, 63, 43
Varnet O, 2002, Wernicke‐Korsakoff syndrome: diagnostic contribution of magnetic resonance imaging, Rev Neurol (Paris), 158, 1181
Weidauer S, 2003, Wernicke encephalopathy: MR findings and clinical presentation, Eur Radiol, 13, 1001, 10.1007/s00330-002-1624-7
White ML, 2005, MR imaging with diffusion‐weighted imaging in acute and chronic Wernicke encephalopathy, AJNR Am J Neuroradiol, 26, 2306
Zhong C, 2005, MR Imaging of nonalcoholic Wernicke encephalopathy: a follow‐up study, AJNR Am J Neuroradiol, 26, 2301
Kirbas D, 2008, The impact of prolonged hunger strike: clinical and laboratory aspects of twenty‐five hunger strikers, Ideggyogy Sz, 61, 317