非乙醇中毒韦尼克脑病误诊3例临床病理分析

Misdiagnosis of 3 patients with Wernicke' s encephalopathy associated with non-ethanol poisoning and literature reviewed

目的报告3例经尸检证实的非乙醇中毒所致韦尼克(Wernicke's)脑病,以期提高对该病认识。方法3例患者均为男性,年龄33～73岁,均无饮酒嗜好,都有不同原因的营养吸收障碍史,行常规尸检及脑部神经病理组织学检查。结果显示第三、四脑室旁、中脑导水管周围及双乳头体区可见点、片状新鲜出血灶。显微镜下见上述区域内的神经细胞数量减少,局部毛细血管增生,并可见点、片状的新鲜出血灶,胶质纤维染色显示有多量的星形细胞增生,髓鞘染色显示轻度的脱髓鞘改变,病理诊断为Wernicke's脑病。结论除了乙醇中毒以外,多种可造成维生素B族缺乏的疾病皆可引起Wernicke's脑病。

Aim To improve the diagnosis of Wernicke' s encephalopathy in nonalcoholic patients.Methods All of three cases of Wernicke' s en-cephalopathy were men without the hi story of alcohol abuse,aged 33-73years,but with various innutrition s.Routine autopsy and neural histop atho-logic examination of brain were cond ucted in the three cases.Results There were recent spots and local haemorrh ages in the mamillary bodies and periventricular regions around the third and fourth ventricles and aqueduct of midbraind.Under light microscope,the number of neurons was decreased,local blood capillary proliferated,and recent hemorrhages were seen in the regions mentioned above.Staining o f gelatinous fiber showed a lot of astro-cytic cell proliferation,and myelin staining displayed the light changes of demyelination.The above was used to make the pathologic diagnosis of Wernicke' s encephalopathy.Conclusion Besides ethanol poisoning,the three cases combined with literatur es show that Wernicke' s encephalopathy could be induced by multiple disease s causing the deficiency of Vitamin B .