韦尼克脑病的前庭功能异常表现

Vestibular dysfunction in Wernicke encephalopathy

目的分析韦尼克脑病(WE)患者的前庭功能异常表现,并探讨其对该病的诊断价值。方法回顾性收集2018年1月至2021年1月就诊于郑州大学第二附属医院眩晕中心的WE患者,对所有患者进行临床神经学评估,治疗前除完善头颅磁共振、血清硫胺素水平检查外,并完成视频头脉冲检查(vHIT)、眼震视图检查及前庭双温试验。结果12例患者均有饮食缺陷病史,其中8例酗酒。12例患者均有行走不稳,7例有头晕,8例出现振动性幻视。有眼肌麻痹者6例,12例患者均可见凝视诱发眼震。12例患者在治疗前vHIT均发现双侧水平半规管病理性扫视波,而垂直半规管仅1例,差异有统计学意义(P<0.05)。8例完善眼震视图检查,所有患者均可检测到双向水平凝视诱发眼震,其中3例伴有垂直眼震,扫视试验结果1例异常,平稳跟踪试验结果3例异常,视动性试验结果1例异常,双温试验结果均存在异常。结论WE患者可出现vHIT异常及双向水平凝视诱发眼震,类似前庭周围及前庭中枢同时受损的特殊异常表现。前庭功能检查有利于WE的诊断,适合于有营养障碍病史并出现头晕或行走不稳怀疑WE患者的筛查。

Objective To analyze the abnormal vestibular function of Wernicke encephalopathy(WE)and to explore its diagnostic value.Methods WE patients who visited the Vertigo Center of the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2021 were retrospectively collected.All patients were evaluated by clinical neurology.Before treatment,all patients completed video head impulse test(vHIT)and video nystagmusgraphy(VNG)in addition to cranial magnetic resonance and serum thiamine level examination.Results All 12 patients had a history of eating defects,including 8 cases of alcoholism.All 12 patients had walking instability,7 cases had dizziness and 8 cases had oscillopsia.Six cases had ophthalmoplegia.All 12 cases showed positive gaze nystagmus.The pathological saccades of bilateral horizontal semicircular canals were found in 12 patients by vHIT before treatment,but there was only 1 patient showing abnormality in vertical semicircular canals,the difference being statistically significant(P<0.05).All patients could detect bilateral,horizontal,gaze-evoked nystagmus,including 3 cases with vertical nystagmus,1 case with abnormal saccade test,3 cases with abnormal smooth tracking test and 1 case with abnormal optokinetic test.There were abnormalities in the caloric test,including 6 cases of bilateral dysfunction and 2 cases of unilateral dysfunction.Conclusions WE patients may have abnormal vHIT and bilateral,horizontal,gaze-evoked nystagmus,which is similar to the special abnormal signs of simultaneous damage of both peripheral and central vestibular dysfunction.Vestibular function test is valuable for diagnosis of WE,and it is suitable for patients with a history of nutritional disorders who have dizziness or walking instability and suspected WE.