PDF(Pubmed)
Abstract：
BACKGROUND: Wernicke encephalopathy (WE) is an acute and potentially fatal neuropsychiatric disorder resulting from thiamine deficiency: its etiology and clinical presentation can be heterogeneous and arduously recognized, especially in children and adolescents.
METHODS: An 8-year-old girl arrived to the emergency room with ataxic gait, nystagmus, and mental confusion after a 10-day history of repeated severe vomiting; her recent clinical history was characterized by restricted nutrition due to a choking phobia, which caused substantial weight loss. Brain magnetic resonance imaging revealed a bilaterally increased T2 signal in the medial areas of the thalami and cerebral periaqueductal region. Diagnosis of WE based on clinical and neuroradiological findings was established and confirmed after labwork showing low serum thiamine. Following psychiatric evaluation, the patient was also diagnosed with avoidance-restrictive food intake disorder (ARFID), which required starting cognitive behavioral therapy and introducing aripiprazole. The patient displayed improvement of the radiological findings after one month and complete resolution of her neurological symptoms and signs.
CONCLUSIONS: Eating disorders like ARFID might forerun acute signs of WE; this possibility should be considered even in pediatric patients, especially when atypical neurological pictures or feeding issues come out.
METHODS: An 8-year-old girl arrived to the emergency room with ataxic gait, nystagmus, and mental confusion after a 10-day history of repeated severe vomiting; her recent clinical history was characterized by restricted nutrition due to a choking phobia, which caused substantial weight loss. Brain magnetic resonance imaging revealed a bilaterally increased T2 signal in the medial areas of the thalami and cerebral periaqueductal region. Diagnosis of WE based on clinical and neuroradiological findings was established and confirmed after labwork showing low serum thiamine. Following psychiatric evaluation, the patient was also diagnosed with avoidance-restrictive food intake disorder (ARFID), which required starting cognitive behavioral therapy and introducing aripiprazole. The patient displayed improvement of the radiological findings after one month and complete resolution of her neurological symptoms and signs.
CONCLUSIONS: Eating disorders like ARFID might forerun acute signs of WE; this possibility should be considered even in pediatric patients, especially when atypical neurological pictures or feeding issues come out.
摘要：
背景：韦尼克脑病（WE）是一种由硫胺素缺乏引起的急性和潜在致命性神经精神疾病：其病因和临床表现可以是异质性的，并且被严格识别，尤其是儿童和青少年。
方法：一名8岁女孩以共济失调步态来到急诊室，眼球震颤,和精神错乱后10天的历史反复严重呕吐;她最近的临床病史的特点是限制营养由于窒息恐惧症,导致体重大幅下降。脑磁共振成像显示，丘脑内侧区域和脑导水管周围区域的T2信号双侧增加。建立了基于临床和神经放射学结果的WE诊断，并在表现出低血清硫胺素的工作后得到证实。在精神病学评估之后,患者还被诊断为回避-限制性食物摄入障碍（ARFID），这需要开始认知行为疗法并引入阿立哌唑。患者在一个月后表现出放射学发现的改善以及她的神经症状和体征的完全缓解。
结论：像ARFID这样的进食障碍可能会出现WE的急性症状；即使在儿科患者中，也应考虑这种可能性。特别是当非典型的神经图片或喂养问题出现时。
方法：一名8岁女孩以共济失调步态来到急诊室，眼球震颤,和精神错乱后10天的历史反复严重呕吐;她最近的临床病史的特点是限制营养由于窒息恐惧症,导致体重大幅下降。脑磁共振成像显示，丘脑内侧区域和脑导水管周围区域的T2信号双侧增加。建立了基于临床和神经放射学结果的WE诊断，并在表现出低血清硫胺素的工作后得到证实。在精神病学评估之后,患者还被诊断为回避-限制性食物摄入障碍（ARFID），这需要开始认知行为疗法并引入阿立哌唑。患者在一个月后表现出放射学发现的改善以及她的神经症状和体征的完全缓解。
结论：像ARFID这样的进食障碍可能会出现WE的急性症状；即使在儿科患者中，也应考虑这种可能性。特别是当非典型的神经图片或喂养问题出现时。
