目的:Wernicke-Korsakoff综合征(WKS)是一种由缺乏硫胺素(维生素B1)引起的神经系统疾病,包括Wernicke脑病和晚期的Korsakoff遗忘综合征。WKS可能是营养不良的次要因素,包括妊娠剧吐(HEG),其特征是怀孕期间严重呕吐。我们介绍了一例HEG,导致可疑的WKS,其中神经心理学评估阐明了具有复杂文化的认知状态,语言,和教育因素。
方法:对一名29岁的西非女性进行心理状态改变的重复评估,减少口头输出,激动,在HEG的背景下无法行走。最初在妊娠21周时进行住院神经心理学评估。MRI显示轻度弥漫性脑萎缩和导水管周围灰质中T2FLAIR高信号的对称病灶,下丘脑,双侧丘脑,周围区皮质,和双侧乳头体。
结果:使用面对面语言一致的口译员进行的初始住院测试显示出明显的多领域损害。推荐团队和测试表现考虑了可能的智力残疾。重新评估的尝试受到医疗并发症和住院时间延长的限制。在健康儿童出生并开始使用兴奋剂药物后5个月后重复住院评估,表现出严重的记忆障碍,但在其他方面改善了认知能力和参与度。结果有助于出院计划,包括以改善功能独立性为目标的认知矫正。
结论:妊娠剧吐所致的Wernicke-Korsakoff综合征是一种罕见但已知的并发症,可产生严重的急性和长期后果。这种情况表明,重复的神经心理学评估可以澄清复杂的医学/文化/语言情况下的认知状态。*(原籍国和主要语言不提供患者隐私)。
OBJECTIVE: Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thiamine (vitamin B1) and includes Wernicke encephalopathy and the later stage of Korsakoff amnesic syndrome. WKS could be secondary to malnutrition, including Hyperemesis Gravidarum (HEG), which is characterized by severe vomiting during pregnancy. We present a case of HEG resulting in suspected WKS where neuropsychological evaluation clarified cognitive status with complex cultural, language, and educational factors.
METHODS: Repeat evaluations of a 29-year-old West-African* woman with mental status change, decreased verbal output, agitation, and inability to walk in the context of HEG. Initially referred for inpatient neuropsychological evaluation at 21 weeks gestation. MRI demonstrated mild diffuse cerebral atrophy and symmetric foci of T2 FLAIR hyperintensities in periaqueductal gray matter, hypothalamus, bilateral thalami, perirolandic cortex, and bilateral mammillary bodies.
RESULTS: Initial inpatient testing with a face-to-face language congruent interpreter demonstrated notable multidomain impairment. Possible Intellectual Disability was considered by the referring team and test performances. Attempts at re-evaluation were limited by medical complications and prolonged hospitalization. Repeat inpatient evaluation 5 months later following birth of healthy child and initiation of stimulant medication, demonstrated profound memory impairment but otherwise improved cognitive capacity and engagement. Results aided in discharge planning including cognitive remediation with goal of improving functional independence.
CONCLUSIONS: Wernicke-Korsakoff syndrome due to Hyperemesis Gravidarum is an uncommon but known complication that can have profound acute and long-term consequences. This case demonstrates that repeat neuropsychological evaluations can clarify cognitive status in complex medical/cultural/language situations. *(country of origin and primary language not provided for patient privacy).