韦尼克脑病(WE)是一种罕见的,威胁生命的情况下,硫胺素缺乏导致Kreb的周期功能障碍,乳酸在脑组织中的积累,和不可逆的认知障碍。用IV硫胺素迅速处理可以逆转该过程。经典的韦尼克共济失调三合会,内存问题,眼异常并不经常出现。凯恩的标准,这需要以下两个:饮食不足,眼部异常,认知或精神状态改变,和小脑功能障碍,对Wernicke的诊断非常敏感和特异,尤其是有酒精使用障碍的患者。再摄食综合征(RS)与WE具有相似的危险因素,包括导致营养不良的疾病状态。RS患者由于口服摄入不足一段时间后重新开始口服营养时发生的硫胺素消耗而发展为WE。我们介绍了一名最初未发现WE的患者,该患者在开始IV硫胺素治疗后出现RS。RS延长了WE的神经系统症状,并导致住院时间延长和身体明显虚弱。在我们的病人身上,我们先于RS,而不是因为它而发生。该案例强调,如果存在这些疾病之一,另一个可能紧随其后。当我们先于RS时,在两种疾病的症状缓解之前,可能需要延长静脉硫胺素治疗.
Wernicke\'s encephalopathy (WE) is a rare, life-threatening condition in which thiamine deficiency causes dysfunction of the Kreb\'s cycle, accumulation of lactic acid in the brain tissues, and irreversible cognitive impairment. Prompt treatment with IV thiamine can reverse the process. The classic Wernicke\'s triad of ataxia, memory issues, and ocular abnormalities is not often present. Caine\'s criteria, which requires two of the following: dietary deficiencies, ocular abnormalities, altered cognition or mental status, and cerebellar dysfunction, is highly sensitive and specific for Wernicke\'s diagnosis, especially in patients with alcohol use disorder. Refeeding syndrome (RS) has similar risk factors to WE, including disease states that lead to malnutrition. Patients with RS develop WE due to thiamine depletion that occurs when oral nutrition is reinitiated after a period of poor oral intake. We present a patient with initially undetected WE who developed RS after the initiation of treatment with IV thiamine. RS prolonged the neurologic symptoms of WE and led to an extended hospital stay and significant physical debility. In our patient, WE preceded RS instead of occurring as a consequence of it. The
case highlights that if one of these disorders is present, the other may not be far behind. When WE precedes RS, prolonged treatment with IV thiamine may be warranted until the symptoms of both disorders resolve.