췌십이지장절제술 후 발생한 지속적인 구토증과 Wernicke 뇌병증
Wernicke Encephalopathy in a Patient with Long-Standing Vomiting after Pancreatoduodenectomy
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초록
Wernicke 뇌병증은 thiamine 결핍으로 인해 발생하는 신경학적 질환으로 눈근육마비, 조화운동불능, 착란이 특징적 증상이다. 저자들은 췌십이지장절제술 후 지속된 구토로 인해 경구영양섭취가 곤란했던 환자에서 오랜 기간 지속된 완전비경구영양법 도중 발생한 Wernicke 뇌병증 증례를 보고하였다. 알코올질환자가 아닌 경우 Wernicke 뇌병증은 관심을 갖지 않으면 임상에서 놓치기 쉬운 질환이다. 특히 적절한 치료가 이루어지지 않았을 때의 사망률 및 후유증을 고려하면 위험요소를 가진 환자의 신경학적 이상에 대한 임상가들의 관심과 빠른 치료적 접근이 필요하다.
Abstract
Wernicke encephalopathy is an acute neurologic disorder attributable to thiamine (vitamin B1) deficiency. We report the case of a 61-year-old female patient who presented Wernicke encephalopathy after surgery for pancreatic head cancer. From the ninth postoperative day, she had suffered from nausea and vomiting and had difficulties ingesting food. She was given total parenteral nutrition (TPN) but lacked enough vitamin (thiamine) supplementation. After 28 days, she developed ataxia, ophthalmoplegia, and mental confusion. The magnetic resonance image showed pathologic change in the medial thalamus, periaqueductal gray matter, medulla, and mamillary bodies. The blood level of thiamine was very low. After intravenous and oral supplementation of thiamine (200 mg/day), consciousness was soon normalized and neurologic symptoms have gradually been improving. Nausea and vomiting disappeared after administration of a low dose of mirtazapine (7.5 mg/day). We emphasize the importance of thiamine supplementation to the patients who suffer from vomiting which hinders them from taking food and who require prolonged TPN.
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