Clinical analysis of alcoholic and non-alcoholic Wernicke′s encephalopathy / 中华全科医师杂志

ABSTRACT

Objective:To review the etiology, clinical manifestations, cranial MRI features and outcome of alcoholic and non-alcoholic Wernicke′s encephalopathy (WE).Methods:The clinical data of 51 WE patients admitted in Peking Union Medical College Hospital from May 1999 to May 2019 were retrospectively analyzed, including 10 cases of alcoholic WE (19.6%) and 41 cases of non-alcoholic WE (80.4%). The clinical manifestations, MRI results, treatment and efficacy of the two groups were compared.Results:The gastrointestinal surgery (17.1%, 7/41) , biliary and pancreatic diseases (14.6%, 6/41) , malignancy (12.2%, 5/41) were the common causes of non-alcoholic WE. Only 39.2% (20/51) of WE patients had typical triad syndrome of mental disorders, ocular symptoms and ataxia. There was no significant difference in the proportion of patients with typical triad syndrome between alcoholic WE and non-alcoholic WE groups [5/10 vs. 36.6% (15/41) , χ 2=0.959, P=0.619]. Mental disorders were more common in non-alcoholic WE [95.1% (39/41) vs. 70.0% χ 2=5.738, P=0.017]. In 45 WE patients undergoing cranial MRI, 53.3% (24/45) had typical symmetry abnormal signals in bilateral thalamus, periaqueductal region and paraventricular region of the third ventricle, in which non-alcoholic WE was more likely to have atypical lesions in comparison with alcoholic WE [66.7% (14/21) vs. 1/3, χ 2=10.578, P=0.001]. Forty-nine patients were treated with vitamin B 1 during hospitalization and symptoms were improved in 91.8% (45/49). The response to vitamin B 1 in non-alcoholic WE was better than that in alcoholic WE [97.4% (38/39) vs. 7/10, χ 2=8.128, P=0.017]. Conclusions:Non-alcoholic Wernicke′s encephalopathy deserves clinical attention. Compared with alcoholic WE, non-alcoholic WE may present mental disorders more frequently, and is more likely to have atypical lesions in cranial MRI, and has better response to vitamin B 1 treatment. Early identification, diagnosis and supplementation of vitamin B 1 can improve the prognosis of WE.