儿童Wernicke脑病的临床特点及MRI表现

Clinical characteristics and MRI features of Wernicke encephalopathy in children

目的:分析儿童Wernicke脑病的临床特点及MRI特征性表现。方法:回顾性分析2015年6月-2019年11月我院7例Wernicke脑病患儿的临床和MRI资料。结果:7例患儿均出现不同程度意识障碍,1例伴有眼肌麻痹,2例有共济失调。主要MRI为脑实质内多部位受累,病变部位包括丘脑内侧(7例)、中脑导水管周围灰质(6例)、第三脑室周围(4例)、四脑室底(4例)、尾状核和豆状核(2例)和乳头体(1例),病灶均对称性分布,T_(1)WI上呈等或低信号,T_(2)WI上呈高信号,T_(2)-FLAIR图像上呈高信号,DWI上5例可见高信号灶。所有患儿经维生素B1治疗3~10天后症状和体征逐渐好转,MRI显示颅内异常信号的范围减小或完全消失。结论:儿童Wernicke脑病的临床和MRI表现具有一定特征性,在及时诊断和治疗后神经系统症状可完全逆转。

Objective:The aim of this study was to analyze the clinical characteristics and MRI features of Wernicke encephalopathy in children.Methods:Clinical and MRI data of 7 children with Wernicke encephalopathy in our hospital from June 2014 to November 2018 were retrospectively analyzed.Results:All patients showed different degrees of unconsciousness.Ophthalmoplegia was found in one patient,and ataxia was found in two patients.MRI of 7 children showed multiple sites involvement.The locations of the lesions included medial thalami(n=7),periaqueductal gray matter(n=6),periventricular region of the third ventricle(n=4),the floor of the fourth ventricle(n=4),lentiform nucleus and caudate nucleus(n=2),and bilateral mammillary bodys(n=1).All lesions were symmetrically distributed,showed iso-or hypo-intensity on T_(1)WI,hyper-intensity on T_(2)WI and T_(2)-FLAIR images.Hyper-intensity lesions on DWI were found in 5 patients.Symptoms and signs improved gra-dually 3~10 days after treatment with vitamin B1,and MRI showed that the range of intracranial abnormal signal reduced or disappeared.Conclusion:Clinical and MRI findings of Wernicke encephalopathy in children have certain characteristics.The neurological symptoms of the patients can be completely reversed after timely diagnosis and treatment.