Non-alkolik nedenlere bağlı gelişen Wernicke ensefalopatisinde manyetik rezonans görüntüleme bulguları
Öz
Amaç: Wernicke
ensefalopatisi (WE) tiamin (vitamin B1) eksikliğine bağlı olarak gelişen
nöropsikiyatrik bir hastalıktır. Sıklıkla kronik alkolizme bağlı olarak
görülmekle birlikte tiamin alım veya emilim eksikliğine neden olan her türlü
durumda ortaya çıkabilir. Bu çalışmanın amacı tedavi edilmediği takdirde ölüme
kadar giden ciddi sonuçlar doğurabilen bu hastalığın tanı ve izleminde manyetik
rezonans görüntülemenin (MRG) önemini vurgulamaktır.
Gereç ve
Yöntem:
Çalışmamıza kurumumuzda hospitalize edilen ve non-alkolik nedenlerle WE tanısı
alan 10 hasta dahil edildi. Hastaların MRG tetkiklerinde tutulum yerlerinin
lokalizasyonuna göre tipik ve atipik bulguların varlığı değerlendirildi. Ayrıca
eşlik eden difüzyon kısıtlılığı varlığı araştırıldı.
Bulgular: Kraniyal MRG’de tipik
tutulum alanları 10 hastada bilateral talamus mediali, 8 hastada bilateral
mamiller cisim, 7 hastada periakuaduktal alan/tektal plak olarak tespit edildi.
Atipik tutulum alanları ise 5 hastada forniks, 4 hastada serebral korteks, 2
hastada putamen, 1 hastada ise serebellum tutulumu şeklinde idi. 8 hastada bu
bulgulara difüzyon kısıtlılığı eşlik etmekteydi.
Sonuç: Sunulan çalışmanın sonuçlarına göre, non-alkolik WE tanılı olgularda MRG’de, alkolik WE tanılı olgularla benzer bulgular gözlenmektedir. Bu hastaların
tanı ve tedavilerinin gecikmemesi amacıyla MR görüntülemenin kullanımının
önemli rol oynadığı sonucuna varılmıştır.
Anahtar Kelimeler
Wernicke ensefalopatisi manyetik rezonans görüntüleme tiamin eksikliği.
Kaynakça
- Saad L, Silva LF, Banzato CE, Dantas C, Garcia C. Anorexia nervosa and Wernicke-Korsakoff syndrome: A case report. J Med Case Rep 2010;4:217.
- Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006;61(4):255-68.
- Loh Y, Watson WD, Verma A, Chang ST, Stocker DJ, Labutta RJ. Acute Wernicke’s encephalopathy following bariatric surgery: Clinical course and MRI correlation. Obes Surg 2004;14(1):129-32.
- Sequeira Lopes da Silva JT, Almaraz Velarde R, Olgado Ferrero F, et al. Wernicke’s encephalopathy induced by total parental nutrition. Nutr Hosp 2010;25(6):1034-6.
- Azim W, Walker R. Wernicke’s encephalopathy: A frequently missed problem. Hosp Med 2003;64(6):326-7.
- Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy. J Neurol. Neurosurg Psychiatry 1986;49(4):341-45.
- Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuororadiol 2007;28(7):1328-31.
- Harper C. The incidence of Wernicke’s encephalopathy in Australia-a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry 1983;46(7):593-8.
- Harper C, Butterworth R. Nutritional and metabolic disorders. In: Graham DI, Lantos PL (eds). Greenfield’s Neuropathology. Vol. 1, 6th ed. London: Hodder Arnold;1997:601-52.
- Zhong C, Jin L, Fei G. MR Imaging of nonalcoholic Wernicke encephalopathy: A follow-up study. AJNR Am J Neuroradiol 2005;26(9):2301-5.
- Thomson AD. Mechanisms of vitamin deficiency in chronicalcohol misusers and the development of the Wernicke Korsakoff syndrome. Alcohol Alcohol Suppl 2000;35(1):2-7.
- Park SH, Kim M, Na DL, Jeon BS. Magnetic resonance reflects the pathological evolution of Wernicke encephalopathy. J Neuroimaging 2001;11(4):406-11.
- Gui QP, Zhao WQ, Wang LN. Wernicke’s encephalopathy in nonalcoholic patients: Clincal and pathologic features of three cases and literature reviewed. Neuropathology 2006;26(3):231-5.
- Zuccoli G, Santa Cruz D, Bertolini M, et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuororadiol. 2009;30(1):171-6.
- Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: A review. Biomed Res Int 2014;2014(4):503-96.
- Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: Review of the literature. AJR Am J Roentgenol 2009;192(2):501-8.
- Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff syndrome and related neurological disorders due to alcoholism and malnutrition. 2nd ed. Philadelphia: FA Davis Company; 1989:123-9
- Bae SJ, Lee HK, Lee JH, Choi CG, Suh DC. Wernicke’s encephalopathy: Atypical manifestation at MR imaging. AJNR Am J Neuroradiol 2001;22(8):1480-2.
- Cui HW, Zhang BA, Peng T, Liu Y, Liu YR. Wernicke’s in a patient with acute pancreatitis: Unusual cortical involvement and marvelous prognosis. Neurol Sci 2012;33(3):615-8.
- Mascalchi M, Simonelli P, Tessa C, et al. Do acute lesions of Wernicke's encephalopathy show contrast enhancement? Report of three cases and review of the literature. Neuroradiology 1999;41(4):249-54.
- Shogry ME, Curnes JT. Mamillary body enhancement on MR as the only sign of acute Wernicke encephalopathy. AJNR Am J Neuroradiol 1994;15(1):172-4.
- Ha ND, Weon YC, Jang JC, Kang BS, Choi SH. Spectrum of MR imaging findings in Wernicke encephalopathy: Are atypical areas of involvement only present in nonalcoholic patients? AJNR Am J Neuroradiol 2012;33(7):1398-402.
- Sugai A, Kikugawa K. Atypical MRI findings of Wernicke encephalopathy in alcoholic patients. AJR Am J Roentgenol 2010;195(5):W372-3.
- Sechi G, Serra A. Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6(5):442-55.
Öz
Aim: Wernicke
encephalopathy (WE) is a neuropsychiatric disease that develops due to the
deficiency of thiamine (vitamin B1). It is often observed due to chronic
alcoholism; however it can arise in any condition that causes deficiency in the
intake or absorption of thiamine. The aim of this study is to emphasize the
importance of magnetic resonance imaging (MRI) in the diagnosis and follow-up of
this disease which can even lead to death when it is not treated.
Materials
and Methods: Ten patients, who had been hospitalized in our institution and
diagnosed as WE due to non-alcoholic reasons, were included in our study. In
the MRI examinations of the patients, typical and atypical findings were
evaluated according to the localization of involvement areas. The existence of
accompanying diffusion restriction was evaluated.
Results: Typical involvement
areas in cranial MRI were determined as bilateral medial thalamus in 10
patients, bilateral mammillary bodies in 8 patients, periaqueductal area/tectal
plate in 7 patients. Atypical involvement areas were determined as fornix in 5
patients, cerebral cortex in 4 patients, putamen in 2 patients and cerebellum
involvement in 1 patient. These findings were accompanied by diffusion
restriction in 8 patients.
Conclusion: According to the
results of the presented study, cranial MRI has similar findings in alcoholic
and non-alcoholic WE patients. We conclude that, the utilization of cranial MRI
in these patients has an important role to prevent the latency of the diagnosis
and treatment.
Anahtar Kelimeler
Wernicke encephalopathy magnetic resonance imaging thiamine deficiency.
Kaynakça
- Saad L, Silva LF, Banzato CE, Dantas C, Garcia C. Anorexia nervosa and Wernicke-Korsakoff syndrome: A case report. J Med Case Rep 2010;4:217.
- Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006;61(4):255-68.
- Loh Y, Watson WD, Verma A, Chang ST, Stocker DJ, Labutta RJ. Acute Wernicke’s encephalopathy following bariatric surgery: Clinical course and MRI correlation. Obes Surg 2004;14(1):129-32.
- Sequeira Lopes da Silva JT, Almaraz Velarde R, Olgado Ferrero F, et al. Wernicke’s encephalopathy induced by total parental nutrition. Nutr Hosp 2010;25(6):1034-6.
- Azim W, Walker R. Wernicke’s encephalopathy: A frequently missed problem. Hosp Med 2003;64(6):326-7.
- Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy. J Neurol. Neurosurg Psychiatry 1986;49(4):341-45.
- Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuororadiol 2007;28(7):1328-31.
- Harper C. The incidence of Wernicke’s encephalopathy in Australia-a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry 1983;46(7):593-8.
- Harper C, Butterworth R. Nutritional and metabolic disorders. In: Graham DI, Lantos PL (eds). Greenfield’s Neuropathology. Vol. 1, 6th ed. London: Hodder Arnold;1997:601-52.
- Zhong C, Jin L, Fei G. MR Imaging of nonalcoholic Wernicke encephalopathy: A follow-up study. AJNR Am J Neuroradiol 2005;26(9):2301-5.
- Thomson AD. Mechanisms of vitamin deficiency in chronicalcohol misusers and the development of the Wernicke Korsakoff syndrome. Alcohol Alcohol Suppl 2000;35(1):2-7.
- Park SH, Kim M, Na DL, Jeon BS. Magnetic resonance reflects the pathological evolution of Wernicke encephalopathy. J Neuroimaging 2001;11(4):406-11.
- Gui QP, Zhao WQ, Wang LN. Wernicke’s encephalopathy in nonalcoholic patients: Clincal and pathologic features of three cases and literature reviewed. Neuropathology 2006;26(3):231-5.
- Zuccoli G, Santa Cruz D, Bertolini M, et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuororadiol. 2009;30(1):171-6.
- Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: A review. Biomed Res Int 2014;2014(4):503-96.
- Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: Review of the literature. AJR Am J Roentgenol 2009;192(2):501-8.
- Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff syndrome and related neurological disorders due to alcoholism and malnutrition. 2nd ed. Philadelphia: FA Davis Company; 1989:123-9
- Bae SJ, Lee HK, Lee JH, Choi CG, Suh DC. Wernicke’s encephalopathy: Atypical manifestation at MR imaging. AJNR Am J Neuroradiol 2001;22(8):1480-2.
- Cui HW, Zhang BA, Peng T, Liu Y, Liu YR. Wernicke’s in a patient with acute pancreatitis: Unusual cortical involvement and marvelous prognosis. Neurol Sci 2012;33(3):615-8.
- Mascalchi M, Simonelli P, Tessa C, et al. Do acute lesions of Wernicke's encephalopathy show contrast enhancement? Report of three cases and review of the literature. Neuroradiology 1999;41(4):249-54.
- Shogry ME, Curnes JT. Mamillary body enhancement on MR as the only sign of acute Wernicke encephalopathy. AJNR Am J Neuroradiol 1994;15(1):172-4.
- Ha ND, Weon YC, Jang JC, Kang BS, Choi SH. Spectrum of MR imaging findings in Wernicke encephalopathy: Are atypical areas of involvement only present in nonalcoholic patients? AJNR Am J Neuroradiol 2012;33(7):1398-402.
- Sugai A, Kikugawa K. Atypical MRI findings of Wernicke encephalopathy in alcoholic patients. AJR Am J Roentgenol 2010;195(5):W372-3.
- Sechi G, Serra A. Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6(5):442-55.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Gönderilme Tarihi | 13 Mart 2018 |
| Yayımlandığı Sayı | Yıl 2019Cilt: 58 Sayı: 2 |
