妊娠呕吐—另一种疾病的“伪装”： 维尔尼克脑病的临床病例

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本文描述了妊娠剧吐（hyperemesis gravidarum）并发维尔尼克脑病的临床病例。该病因是由于硫胺素（维生素B1）缺乏引起的。疾病的诊断往往因其临床表现与其他多种疾病的相似性而变得困难。及时诊断和早期治疗可以降低疾病严重程度以及潜在的不可逆并发症和死亡风险。本病例的特征在于，32岁妊娠女性因妊娠剧吐而发展出维尔尼克脑病的经典三联症，这种情况仅见于16%的患者。患者首先出现共济失调和眼球震颤，随后出现记忆障碍伴虚构症状。在脑磁共振成像（MRI）中，在T2加权成像（SE和FLAIR）序列中，丘脑背内侧核、第三脑室下室管膜区域和导水管周围灰质中发现双侧对称性高信号区。随即对患者开始维尔尼克脑病治疗，静脉注射硫胺素200 mg，每日3次。治疗后病情呈现积极变化。妊娠过程无其他并发症，并顺利分娩出一名足月健康女婴。在产后阶段，患者仍有闭眼时加重的步态不稳和非系统性头晕。

作者简介

Ekaterina A. Sinayskaya

I.M. Sechenov First Moscow State Medical University

编辑信件的主要联系方式.
Email: sinayskaya.28@gmail.com
ORCID iD: 0009-0003-7232-7408

6th year student

俄罗斯联邦, Moscow

Natalya S. Zemlina

I.M. Sechenov First Moscow State Medical University

Email: zemlina_n_s@staff.sechenov.ru
ORCID iD: 0000-0001-6393-9961
SPIN 代码: 7667-2482

Assistant

俄罗斯联邦, Moscow

Andrey V. Murashko

I.M. Sechenov First Moscow State Medical University

Email: murashkoa@mail.ru
ORCID iD: 0000-0003-0663-2909
SPIN 代码: 2841-9638

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Olga E. Zinovieva

I.M. Sechenov First Moscow State Medical University

Email: zinoveva_o_e@staff.sechenov.ru
ORCID iD: 0000-0001-5937-9463
SPIN 代码: 6378-5608

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Dmitry E. Prokhorov

I.M. Sechenov First Moscow State Medical University

Email: dm_prokhorov@mail.ru
ORCID iD: 0000-0001-7149-726X
SPIN 代码: 6847-2440

Neurologist

俄罗斯联邦, Moscow

参考

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  2. Rakhmanova TKh, Isenova SSh, Svyatova GS, Egle M. Modern view on the etiology of excessive vomiting of pregnant women. Newsletter of KazNMU. 2020;(3):7–12. EDN: PIVQXU
  3. Thomson M, Corbin R, Leung L. Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis. J Am Board Fam Med. 2014;27(1):115–122. doi: 10.3122/jabfm.2014.01.130167
  4. Miriam E. Gestational malnutrition, hyperemesis gravidarum, and Wernicke’s encephalopathy: What is missing? Nutr Clin Pract. 2022;37(6):1273–1290. doi: 10.1002/ncp.10913
  5. Popa S, Barsan M, Caziuc A, et al. Lifethreatening complications of hyperemesis gravidarum. Exp Ther Med. 2021;21(6). doi: 10.3892/etm.2021.10074
  6. Bolin M, Åkerud H, Cnattingius S, et al. Hyperemesis gravidarum and risks of placental dysfunction disorders: A population-based cohort study. BJOG. 2013;120(5):541–547. doi: 10.1111/1471-0528.12132
  7. Dean CR, Bruin CM, O’Hara ME, et al. The chance of recurrence of hyperemesis gravidarum: A systematic review. Eur J Obstet Gynecol Reprod Biol X. 2020;5:100105. doi: 10.1016/j.eurox.2019.100105
  8. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442–455. doi: 10.1016/S1474-4422(07)70104-7
  9. Wijnia JW. A clinician’s view of Wernicke-Korsakoff syndrome. J Clin Med. 2022;11(22):6755. doi: 10.3390/jcm11226755
  10. Grigoryeva VN, Guzanova EV, Muchin VV. Wernicke’s encephalopathy, central pontine myelinolysis and polyneuropathy in the patients with indomitable vomiting of pregnant (hyperemesis gravidarum). Neurological Journal. 2016;21(3):131–141. EDN: WMWJBD
  11. Kareem O, Nisar S, Tanvir M, et al. Thiamine deficiency in pregnancy and lactation: implications and present perspectives. Front Nutr. 2023;10:1080611. doi: 10.3389/fnut.2023.1080611
  12. Sivolap YuP, Damulin IV. Wernicke–Korsakoff syndrome. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(4):76–80. EDN: TCVOXZ doi: 10.14412/2074-2711-2014-4-76-80
  13. Galvin R, Bråthen G, Ivashynka A, et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010;17(12):1408–1418. doi: 10.1111/j.1468-1331.2010.03153.x

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2. Fig. 1. Magnetic resonance imaging of the brain (Patient K.) (cross-sectional image at the level of the III ventricle and mediodorsal nucleus of thalamus): the arrows indicate symmetrical MR signal enhancement.

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