Cause the development and manifest Wernicke-Korsakoff syndrome. Wernicke's syndrome (encephalopathy): increased awareness of this serious, mysterious illness.

51.2 , 10. 6 OMIM

Etiology

avitaminoses
gastrointestinal diseases
nevgamovne vomiting vagitnikh
vomiting when treated with digitalis drugs
evil new creation
Trivalium hemodialysis
Worm infestation

Pathogenesis

Vitamin B 1 serves as a cofactor for several enzymes, including transketolase, pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase. In case of avitaminosis B 1, the utilization of glucose by neurons is reduced and mitochondria are weakened. Accumulation of glutamate due to decreased activity of alpha-ketoglutarate dehydrogenase against the background of energy deficiency can have a neurotoxic effect. As a result, there is a change in the number of neurons, demyelinization and gliosis of the periventricular gray area. The most commonly affected areas are the medial hypothalamus, which is likely to cause amnesia, deformation of the ossoma-like bodies, vermiform cerebellum and nuclei of the III, VI and VIII cranial nerves.

The acute form of alcoholic encephalopathy is increasing in men aged 35-45 years. There is also a chronic form of alcoholic encephalopathy – Korsakoff psychosis. For all forms of encephalopathies, a characteristic period of pre-illness of a different stage of trivality: from many years to a day or more, the shortest period occurs in the superacute form - 2-3 years. This period is characterized by the development of asthenia with significant adynamia, decreased appetite, even to the point of full-blown anorexia, and a decrease in fatty and protein-rich fluids. Avoiding one of the symptoms is vomiting, which is important for wounds. Often symptoms include burning, swelling, abdominal pain, and unstable stomach. Physical exercise will occur. For the prodrome, typical types of sleep disturbances include difficulty sleeping, light, shallow sleep with vivid nightmares, frequent awakenings, and early awakenings. An unhealthy sleep-wake cycle may occur: sleepiness during the day and sleeplessness at night. The most common symptoms are chills and fever, which are accompanied by sweating, palpitations, heart pain, a feeling of lack of wind, and ringing at night. In various areas of the body, usually at the ends, skin sensitivity is impaired, in the muscles of the body, fingers, etc., the skin is affected.

clinical picture

The classic triad of symptoms - ophthalmoplegia, ataxia, confusion of the eyes - is even worse in a third of the cases. The beginning of illness, as a rule, is delirium with scanty, sudden, one-man hallucinations and illusions. Anxiety and fear dominate. It is important to be wary of the engine of arousal in seemingly stereotypical activities (as in ordinary or professional occupations). Periodically, there may be a development of short-term periods of fatigue with increased tone of the muscles. People who are sick can mumble and coax out new words, making physical contact with them impossible. After a few days, a stunned state develops, which can then turn into a stupor, and in the event of an unpleasant encounter, into a coma. In lonely moments, a stuporous stupor is preceded by an apathetic stupor.

Depression of mental state is accompanied by intensification of somatic and neurological disorders; The rest show great diversity. Fibrillary movements of the tongue, lips and wounds are often avoided. Folding fleeting arms are constantly being identified, in the middle of which are three-dimensional ones, which are interspersed with communion, choreimorphic, athetoideal and other types of arms. The muscle tone can be either increased or decreased. Ataxia never develops. Nystagmus, ptosis, strabismus, unruly appearance, and points of discord (anisocoria, miosis, weakened light response to its complete decline) and impaired convergence are detected. Polyneuritis, mild paresis, the presence of pyramidal signs are often indicated, and the rigidity of polylithic ulcers may be associated with meningeal symptoms. The ailments are physically cleared up, they look older for their fate. The person made a mess. Language of raspberry color, smoothed out papillae. The increased temperature is indicated. Continuous tachycardia and arrhythmia, arterial pressure decreases when the pressure becomes stronger, and tends to hypotension and collapse. Hepatomegaly is present, and diarrhea is often present.

The epigastric course is characterized by the fact that important forms of delirium (occupational or mental) develop in the kidney. Vegetative and neurological symptoms of the prodromal period sharply intensify. Body temperature drops to 40-41 °C. After one or a few days, a state of stupefaction develops, followed by a transition to coma. Death often occurs on days 3-6.

Wernicke's encephalopathies may accompany other manifestations of eating disorders - sedation, in 80% of patients there is polyneuropathy. Amblyopia and spinal spastic ataxia are more common. Rarely, tachycardia and orthostatic hypotension, which can result from a disorder of the autonomic nervous system or be symptoms of the vulgar form of beriberi. Torukhov Rosladi Tydinna Vvedennya Tiamin, Todi Yak Ataxiya to get to the end, and approximately in the half ailment of the renewal of it is not wounded in the course of the course of the course of the stain, Choviga, with widely rosicous legs. Apathy, drowsiness, confusion and confusion may also occur gradually. If the regression of these disorders first occurs, fixation amnesia - Korsakov's syndrome - may result. Tse is a partial companion to Wernicke encephalopathy; in essence we are talking about one illness - Wernicke-Korsakoff syndrome. As a result of Gaye-Wernicke syndrome, there may be a development of a psychoorganic syndrome: loss of memory, confabulation, confusion in the sequence of events. Mortality is often associated with concomitant illnesses, such as pneumonia, or any other illness.

Diagnostics

The diagnosis must be made based on the clinical picture and history. It is necessary to differentiate from delirium, brain swelling, schizophrenia, and acute symptomatic psychoses.

Laboratory data: in peripheral blood – macrocytic anemia; in liquor – slight movement of protein (<90 мг% ). КТ/МРТ: атрофия сосцевидных тел.

Likuvannya

Thiamin 50 -100 mg internally or internally two days until clinical improvement. Be aware of the possibility of developing anaphylactic shock when thiamine is administered;
Other vitamins, such as pyridoxine, cyanocobalamin, ascorbic and nicotinic acids; anabolic steroids;
Magnesium sulfate, 2-4 ml of 25-liter dose of internal ulcer - for the correction of hypomagnesemia, which often accompanies hypovitaminosis B 1;
Therapy of the main illness.

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What characterizes Gaye-Wernicke Syndrome?

Natalya, having become increasingly hostile, reported to Sonya about her brother’s injury, and first realized the whole serious side of this news.
Vaughn rushed to Sonya, hugged her and began to cry. - A few injuries, but also injuries to the officers; “He’s healthy now, he can write himself,” she said through tears.
“It’s obvious that all of you women are crybabies,” said Petya, walking around the room with bold, large steps. - I am so glad and, in truth, even radiant that my brother was so proud. All you nurses! You don’t understand anything. – Natalka laughed out of tears.
- You didn’t read the leaves? - Sonya asked.
- I didn’t read it, but she said that everything was over, and that he was already an officer.
“Thank God,” said Sonya, crossing herself. - Ale, maybe she fooled you. Let's go maman.
Petya moved around the room.
“If I had been in Mikolushka’s place, I would have killed even more Frenchmen,” he said, “they stink like crazy!” “I would beat them so much that they would make a lot of money from them,” Petrik said.
- Movchi, Petre, what a fool you are!
“I’m not the fool, but the fools are the ones who cry like fools,” said Petya.
- Do you remember anything? - After the Khvylin’s war, Natalka was fed with rapt. Sonya chuckled: “Do I remember Nicolas?”
“No, Sonya, you remember him so that you remember him well, so that you remember everything,” Natalka said with an old gesture, perhaps trying to give her words the most serious meaning. “And I remember Nikolenka, I remember,” she said. – I don’t remember Boris. I don’t remember at all.
- Yak? Do you not remember Boris? - Sonya asked with wonder.
- Not the ones I don’t remember - I know what wine it is, but I don’t remember it as well as Nikolenka. Yo, I’ll close my eyes and remember, but Boris won’t (she’ll flatten her eyes), no, nothing!
“Ah, Natasha,” said Sonya, choking and seriously marveling at her friend, neither she respected her with an unworthy sense of those that she had little intention of saying, nor she told anyone else with whom she could not fry. - I killed your brother once, and, no matter what he did with him, with me, I will never stop loving him for the rest of my life.
Natasha marveled at Sonya with gleeful eyes and muttered. Vona realized that what Sonya said was true, that it was just as bad as Sonya said; But Natalya had never seen anything like this before. Vaughn believed what could have happened, but she didn’t understand.
- Will you write youma? - She asked for it.
Sonya became confused. Nutrition about those how to write to Nicholas and what it is necessary to write and how to write, there was nutrition, how it tormented her. Now, if he is already an officer and an injured hero, would it be good for him to tell him about himself and about those challenges that he suffered from before her.
- Don't know; “I think if you write, I’ll write,” she said.
- And is it not shameful for you to write to you?
Sonya chuckled.
- No.
- And it’s a shame for me to write to Boris, I don’t write.
- Why is it so bad? Well, I don't know. It’s inconsiderate, it’s disgraceful.
“And I know why she’ll be in disrepute,” Petya said, grimacing at Natalka’s first respects, “to the one who was buried in someone’s eyes with eyepieces (that’s how Petya called his namesake, the new Count Bezukhy); is now buried in the spivak’s (Petya speaking about the Italian, Natasha’s teacher in the back): the axis of her and sorno.
“Petya, you’re stupid,” Natalka said.
“Don’t be too bad for you, matinko,” said nine-year-old Petya, who was also an old brigadier.
The Countess Bula was prepared by Anni Mikhailovna's natyaki for lunch hour. Having arrived, she, sitting on the armchair, did not take her eyes off the miniature portrait of a son embedded in a snuffbox, and tears came to her eyes. Hanna Mikhailovna walked up to the countess’s room with a sheet of paper on her back and sat down.
“Don’t come in,” she said to the old count who was behind her, “then,” and she closed the doors behind her.
The Count put his ear to the castle and began to listen.
Immediately I felt the sounds of random proms, then one sound of Ganny Mikhailovna’s voice, as she spoke a long time ago, then a chatter, then a murmur, then again offensive voices and all at once speaking with joyful intonations, and then crocs, and Hanna Mikhail She gave me the door. On the face of Ganni Mikhailovny there was the proud expression of the operator, who had completed an important amputation and was introducing the public to appreciate his mystery.
- C'est fait! [It’s broken on the right!] - she said to the count, with a calm gesture pointing at the countess, who was holding a snuffbox with a portrait in one hand, a sheet of paper in the other, and pressed her lips first to this, then to the other.
Having greeted the count, she extended her arms to him, hugged his fox’s head, and through the fox’s head again marveled at the sheet and the portrait and again, in order to press them to her lips, she pulled the fox’s head back a little. Vira, Natalya, Sonya and Petro went to the room, and reading began. The sheet briefly described the campaign and two battles in which Mikolushka took part, becoming an officer, and said that he kisses the hands of mom and dad, asking for their blessings, and kisses Vera, Natasha, and Petya. In addition, he bows to m r Sheling, and m m Shos and the nanny, and, in addition, to ask to kiss the way to Sonya, who loves so well and who knows everything about him. Feeling this, Sonya's face turned so dark that tears came to her eyes. And, unable to see the look that was being made at her, she ran into the hall, ran wild, spun around, and, blowing her cloth with a balloon, turned red and grinned, sitting down for a moment. The Countess was crying.
- What are you crying about, maman? - said Vera. - For everything you write, you need to be happy, not cry.
This was entirely fair, and the Count, the Countess, and Natalka all marveled at her with kindness. "And who did she hit like that!" thought the countess.
Mikolushka's sheet has been read hundreds of times, and those who have listened to him for years have come to the countess, who did not let go of his hands. Tutors, nannies, Mitenka, and other famous people came, and the countess re-read the sheet of paper every time with a new note and immediately discovered new honors from her Mikolushka behind this sheet. How wonderful, supernatural, and joyful it was that her son was the same son who, with his little cricked limbs, burst into her 20 years ago, the same son for whom she got married to the pampered count, the same son who learned to say before: “pear ”, and then “baba”, whose son is now there, near a foreign land, at someone else’s middle ground, a man’s warrior, alone, without help and servitude, to fight there for his right. All the world's evidence points to the fact that children, in an unmistakable way like strollers, become men without dying for the countess. A married woman in her skin was so sublime for her, as if there were not millions of millions of people who got married just like that. Yak did not run 20 Rocks, Shcho is small, Yaku lived a dies there with a non -ni pіd with a heart, she screamed bogs of her chest, I sorted out, so I did not run the same, they could be tim tim strong, Khorombham Cholbrim Chionik , through the eyes of the blue ones and the people they are now, judging from this sheet.
- What a calm, as he describes nicely! - she said, reading the description of part of the sheet. - What a soul! Nothing about myself... nothing! About some Denisov, and he himself, perhaps, is funnier than all of them. Don’t write anything about your suffering. What a heart! How will I recognize him! And how I guessed it! Without forgetting anyone. I said it again and again, if it’s like that, I said it again...

Wernicke's encephalopathy is a neurological disease that causes damage to the brain due to deficiency of vitamin B1 or thiamine. Wine is associated with alcohol intoxication, vomiting, and fasting.

The damage to the cerebrum, hypothalamus, and midbrain results in hallucinations, madder, fluidity wanders, and orientation to space decreases. Through a correct diagnosis and timely rejoicing, the life of the sick person can be preserved.

Causes of pathology

On the one hand, the lack of thiamine interferes with the process of removing glucose from the body. This causes damage to mitochondria, which supply energy to the body. On the other hand, the presence of thiamine is necessary in the body for enzymes to perform their functions. In other cases, glutamate accumulates, which causes damage to the nerve cells. As a result, neurons shorten, the fluidity of nerve impulses decreases, Wernicke encephalopathy develops, which can occur:

in gostry form;
in chronic

There is a low number of factors that can provoke pathology:

avitaminosis;
trivale fasting;
continuous vomiting during pregnancy;
ailments of the intestinal tract;
oncological swellings;
detoxification of the body with the help of a foxglove extract;
disruption of speech exchange;
hemodialysis;
Worm sickness.

Regardless of the significant influence of factors, doctors consider chronic alcoholism itself to be blamed on vitamin B1 deficiency.

Symptoms of Wernicke encephalopathy

Back in the 19th century, the French doctor Guyet and the German psychoneurologist Wernicke described this pathology. Gaye called it diffuse encephalopathy, and Wernicke called it upper acute polyencephalitis.

Current neurologists recognize the concept of Gaye-Wernicke syndrome as three different syndromes, which they call a triad of symptoms:

Ataxia is mixed.
Disorder of the functions of the ruhu ochima (ophthalmoplegia).
Disruption of the role of the central nervous system, related to information, awareness, learning, memory.

Overcoming the illness can be divided into three stages.

As the pathological illness begins to develop, it is necessary to sleep throughout the day through difficulties due to sleepiness, frequent awakenings at night, associated with nightmares. A lack of strength prevents them from concentrating on Wikonian information.

The initial or prodromal period affects the skin patient differently - from many years to many months.

At another stage of development, the syndrome develops the following manifestations:

Appetite decreases right up to the point of seeing people again;
One senses apathy and loss of strength;
Beware of losing the sensitivity of the skin and muscles;
the ruins of the tulub change, as they blame themselves and are not controlled by people;
an anxious state appears, almost like fear;
the back door is croaking because of the misfortune of the wind;
intestinal problems are caused;
there is pain in the schluka;
tediousness and vomiting are frequent;
The functioning of the heart is impaired, the pulse changes, and sweating increases;
immersed in the star.

When the illness transforms into the acute phase, signs of a neurological nature appear:

knowledge wanders;
Blame problems with ophthalmoplegia (ophthalmoplegia);
it is important to concentrate your respect;
it is difficult to orientate oneself in space;
to revel in the rose-colored richness;
apathy and depression sets in;
knows a sense of reality;
are hallucinations, madder;
the flow volume decreases.

In this situation, the psyche of the sick changes. They shut themselves off, don’t talk to strangers, and ignore food. Neurological damage manifests itself in the appearance of the face and tongue. There is a looseness of the meat, the seeds do not react to light.

Patients with symptoms of Wernicke's encephalopathy lose their vagina, appear puffy, and their tongue becomes red. Temperature rises, sweating increases, heart function deteriorates, arrhythmia occurs, and the patient often loses consciousness. After a few days, a stunned state sets in, which can develop into a coma. Because damaged cells in the brain are absurd in life, in human life.

If the patient developed skewed eyes, the coordination of the arm changed, which indicates neurological illness.

Diagnostic investigations

To diagnose encephalopathy, consultations with a neurologist, an ophthalmologist, a therapist and a psychotherapist are necessary. The underlying picture of illness becomes clearer after taking a history: education about the condition, identification of symptoms. When looking at the sick person, respect for his life begins to grow. On the skin, which loses elasticity and becomes dry and bristly. This indicates deformation of the nails, hair may have a dry appearance.

To confirm the correct diagnosis, administer thiamine. The patient's progress in 3-4 years confirms the diagnosis.

Diagnostic investigations are considered:

MRI of the brain;
investigation of the spinal cord;
EEG – electroencephalography;
modification of the calorie response;
blood tests and cuts.

A blood test for biochemistry shows that the protein has changed and the pyruvic acid (pyruvate) has increased. You can also find out about the presence and availability of enzymes required for cooking.

The cerebrospinal region is monitored by lumbar puncture to detect deterioration.

MRI and CT can detect changes in the structure of the brain, determine the presence and presence of pathological vessels, and malignant tumors. EEG indicates abnormal processes in the brain.

Data from the investigation include similar illnesses: schizophrenia, psychosis, swelling of the brain.

Likuvannya

If Wernicke's illness is suspected, the patient is admitted to the hospital and emergency therapy is instituted. The essence of the bath lies in the addition of water and thiamine to the body. Vitamin B1 is administered internally to the kidney for at least 5 days, then internally. After staying at home, thiamine should be given obligatory glucose. In other cases of illness, I will begin to worry about annihilation.

The following statements must be made:

a complex of vitamins, which consists of retinol, tocopherol, calciferol, ascorbic, folic, nicotinic acids;
magnesium sulfate;
magnesium oxide.

After administration of thiamine, the fluidity of the eyes is restored in a short period of time, and nystagmus is prevented.

It is important for the patient to become stagnant:

psychotropic drugs - “Barbamil”, “Diazepam”, “Haloperidol”;
antioxidant substance – “Cytoflavin”;
nootropics - "Piracetam", extract "Ginko Biloba";
ship's products - "Vinpocetine", "Pentoxifyline".

These drugs help reduce oxidative reactions in the body, improve brain function and blood flow, and relieve pain.

A narcologist and a psychiatrist will take the fate of the sick person. Their actions are aimed at identifying the main cause of illness – alcoholism. It is necessary to ensure that the patient receives a thorough bath. In this case, you need to radically change your life and get rid of your lips.

Treatment of alcoholic encephalopathy of Gaye-Wernicke is impossible without food correction. Include fatty, greased, pepper-based, processed foods, as well as canned goods that relieve problems in the internal organs.

In case of untimely treatment or constant absence, the brain cells are destroyed, which leads to the patient’s degeneration. It manifests itself like this:

memory is lost;
mental disorders develop;
swelling of the brain disappears;
change in pinkness;
knows rokhov's activity;
brain tissue atrophies;
the exchange of speeches is disrupted;
coma.

Forecast and prevention

Gaye-Wernicke syndrome has a favorable prognosis once the diagnosis is correct and treated promptly. As many cases of illness as possible due to this pathology, less than 20% will result in the death of the patient. If the disease does not respond to proper treatment, liver failure develops, weakened immunity opens the way to various infections.

After a course of thiamine administration, the patient’s condition becomes brighter, since the level of cerebral cell tension is critical. He is discharged from the hospital, but this does not mean that he is healthy. To continue the cleanliness of the renewal of pink and rokhovy fluids in the minds of the clinic.

Gaye-Wernicke encephalopathy is a serious, or reversible, neurometabolic disorder resulting from a deficiency of thiamine (vitamin B1).

Vitamin B1 is an important coenzyme and takes part in many biochemical processes, such as the decarboxylation of ketone acids. Particularly important is the presence of this vitamin for the functioning of the central nervous system. With its deficiency, the ability of neurons to utilize glucose (their main living substrate) is impaired and their mitochondria are impaired. Moreover, the most important thiamine is in the metabolism of the perineum and cerebrospinal fluid, which means that when vitamin B1 is deficient, the farms suffer earlier than others.

Thiamine molecule model

First of all, there was a reaction to the acute deficiency of thiamine, according to the descriptions of Karl Wernicke in Germany and the name “upper hemoragic encephalitis”. In the International Classification of Diseases of the 10th Revision (ICH-10), encephalopathy, named after Gay-Wernicke, is attributed to illness of the endocrine system, disorders of eating and disruption of speech metabolism (code E51).

Causes of encephalopathy

Inadequate food over a period of 2-3 days is already insufficient for thiamine to manifest the first signs of Wernicke's encephalopathy. However, there are very few other reasons for this:

systematic abuse of alcoholic drinks;
illness of organs and poisoning (recurrent vomiting, repeated diarrhea, pyloric stenosis, varicose vein disease of the 12-fingered intestine, intestinal obstruction or perforation, pancreatitis, etc.);
diarrhea as a result of taking medications (for example, treating depression with medications or administering high doses of nitroglycerin intravenously);
lack of magnesium, necessary for the absorption of thiamine, in Crohn's disease, bowel resection, or in case of chronic use of diuretics;
nevgamovne vomiting at the vagitniks;
oncological illnesses and chemotherapy courses;
undergoing surgical procedures (gastrectomy, colectomy, bypass anastomosis, etc.);
polishing rice as the basis of food;
mimovilna vidmova vid izhi (anorexia nervosa);
It is possible that a genetic disorder may be evident before the development of such encephalopathy.

Regardless of the fact that Wernicke encephalopathy can arise from any other causes, in practice most often this type of pathology is limited as a result of the patient’s addiction to alcohol.

Chronic alcohol intoxication is a major risk factor for the development of Wernicke encephalopathy

clinical picture

Acute encephalopathy identified by Gaie-Wernick is characterized by a triad of symptoms:

Ophthalmoplegia and nystagmus. Surrounding lesions are most obvious, and their lack of inheritance from various causes can greatly complicate the diagnostic process. Upon examination, there is bilateral paresis of the aqueductal nerve (horizontal double vision), obliquity and nystagmus, which can be relieved by turning the gaze in the horizontal plane.
Ataxia. The destruction of the country is to be shown to ourselves, before we remain in Russia. Some patients are unable to maintain a standing position and shift their feet without additional support.
Dark information. The patient is lying, does not show himself in any way, and is ready to expect something new. It doesn't indicate that you're fed, so you can fall asleep right before the hour of prayer. People are not oriented in space and often have trouble recognizing familiar people. In many patients, during fasting, the doctor shows impairment of long-term memory as a manifestation of Korsakoff amnestic syndrome. Further depression can lead to suppression of information and coma.

The most common manifestation of Wernicke encephalopathy is confusion of information

Along with these symptoms, body temperature also decreases, weakness appears, and tachycardia develops at rest.

The stage develops due to the destruction of food and obvious deterioration of the body, accompanied by signs of peripheral polyneuropathy. Some patients may show signs of alcohol withdrawal.

Before late symptoms there may be an increase in body temperature, spastic paresis, and hyperkinesis.

Korsakoff syndrome

Acute alcoholic encephalopathy and Korsakoff syndrome, which often go side by side, are united by one common name - Gaye-Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome manifests itself in failure to memorize new information (in which case old memory is better than new information), which is often associated with problems with memory.

However, since Wernicke's encephalopathy is most often accompanied by temporary metabolic disturbances, which usually occur with adequate treatment, then with Korsakoff's syndrome, structural damage has already developed and the prognosis is not so favorable. Thus, Korsakoff syndrome is now an important step in the development of illness, as it is more important to respond to treatment.

Wernicke-Korsakoff syndrome can be caused by non-alcoholic mothers. The conditions associated with acute thiamine deficiency, described earlier, in some cases may result from traumatic brain injury or induce internal anesthesia.

Diagnostics

The standard for diagnosing alcoholic encephalopathy is MRI. This diagnostic method itself makes it possible to identify the main morphological substrate of Gaye-Wernicke encephalopathy – necrosis of the mammillary bodies.

The disease can often occur without symptoms, so the doctor must carefully assess the possibility of developing this pathology in individuals who suffer from alcoholism. In such people, it is necessary to admit the presence of polyvitamin deficiency (and first of all vitamin B1 - thiamine) deficiency and immediately fight it.

Come to the celebration

In the first child (up to 72 years of age), when the first symptoms of encephalopathy have disappeared, they respond well to replacement therapy with vitamin B1 – thiamine. Moreover, the administration of the vitamin may be internal, until it reaches a high concentration in the body. When thiamine is available, administer it at a dose greater than 1000 mg. After 5-7 days of injection, the patient is transferred to oral administration of medicines, which also affects a large number of people. Vitamin dosage gradually decreases after 2 days of oral administration.

The treatment of patients with Wernicke's encephalopathy relies on the administration of Thiamine.

The severity of thiamine intake varies depending on the severity of the illness, which on average is about 3 months, and with the development of Korsakoff syndrome, a few fatalities may occur.

Also, thiamine administered internally in a short course with an immediate transition to internal administration may be prescribed to patients who are experiencing the development of this pathology in a group of people at risk.

Vitamin B1 for oral administration

With timely internal administration of the necessary vitamins:

The keratinous lesions will soon go away, although nystagmus can be avoided;
The patient's condition is equal to the calm, turns around, and during the course continues to be left unresponsive.

Along with vitamin B1 therapy, it is important to eliminate stress and electrolyte deficiency and maintain adequate water-electrolyte balance.

Cream to replenish thiamine deficiency, prevent the development of Wernicke encephalopathy and reduce the amount of carbohydrates in the diet, the fragments themselves are absorbed from the body due to increased consumption of vitamin B 1. Also, the unique administration of glucose to individuals who suffer from alcoholism, as a result, promotes the development of encephalopathy.

Thus, Wernicke's encephalopathy is associated with illnesses, which is important in diagnosis, but also because of its efficiency, it is often the result of all treatment.

Wernicke-Korsakoff syndrome is a complex of associated neuropsychiatric symptoms caused by deficiency of vitamin B1 (Thiamine). Develops with prolonged alcoholism, poorly acquired habits of life. Illness manifests itself in the form of rashes, paralysis of the eyes, and madder.

Cause the development of Wernicke-Korsakoff syndrome

Gaye-Wernicke-Korsakoff syndrome is a collection of clinical manifestations caused by vitamin B1 deficiency with subsequent hemorrhage in the brain. First of all, this phenomenon was observed in patients with chronic alcoholism. Signs of the syndrome were described in a woman who suffered from constant vomiting after using sulfuric acid.

Develops under attack:

Fasting for cervical cancer oncology to relieve pain.
Anorexia.
Nestacha Tiamina in izhi.
Disease of the intestinal tract, which reduces the supply of vitamin B1 to the skin.
Chronic alcoholism.
Failure to clean up vomiting with exhaustion, vomiting, alcoholism with Mallory-Weiss syndrome.
Onset of secondary immunodeficiency.
Hemodialysis in patients with impaired function is not effective.
Worm infestations.

Rozvitok sick

Wernicke's syndrome is an encephalopathy that develops in aphids, other hemorrhages, usually in the substructure: the tuberculum, the capillary bodies. The middle cerebrum and the medial part of the hypothalamus are also obtained before the pathological process. There is degradation of the white speech - demyelinization of the conductive pathways that connect the nerve cells to each other.

The interclinary tract of the corneal eminence, the hypothalamus, and the midbrain suffers from thiamine deficiency due to the fact that in these areas vitamin vicorist is used as a cofactor for transketolase. A lack of this vital element leads to energy deficiency in the brain, and especially in the visual areas.

Hypovitaminosis of vitamin B1 leads to the accumulation of an excitotoxic substance - glutamic acid, which has a stimulating effect on neurons. Overflow is the cause of further damage to the work of nerve cells and their death.

It’s worthwhile to know what alcoholism is: the main causes and treatment of alcoholic amnesia.

Important: alcohol causes all sorts of illnesses.

The hypothalamus regulates autonomic function, which determines the tone of the vessels. This lesion in Wernicke's syndrome leads to swelling and bleeding of the brain. The bent cells and white nerve fibers are replaced by glia, or interclinary cord.

The vermis of the cerebellum, the centers of the cervical, avulsary and anterior roach nerves are also exposed.

Symptoms of Wernicke-Korsakov illness

Damage to various structures of the brain leads to disruption of their function. Wernicke-Korsakoff syndrome includes the following clinical symptoms:

, nystagmus (three hundred eyeballs).
Headache.
Nervous, motor unsettled.
Amnesia, confabulation (memory confusion).
Delirium: madder, hallucinations.
Asthenia, adynamia.
Nudota, vomiting, baking, destruction and emptying.
Vegetative disorders: sweating, chills, flushed appearance.

Damage to the cerebellum results in ataxia, which is manifested in unstable movement and impaired coordination of the arms. Bleeding in the area where the nucleus of the spinal nerve is located can lead to ophthalmoplegia, or paralysis of the eyeballs.

It is possible to change the reflex zone, their asymmetrical reaction to light. The results of the cold test are equal to the norm, most often reduced.

Damage to the hypothalamus and its nuclei causes autonomic damage:

increased body temperature and chills;
expansion and sound of skinny vessels;
changing the color of the denunciation.

In the Stovburian part, the nucleus of the vagus nerve is dissected, and swelling and bleeding in this place lead to disorders of the herbal system, which is in control. This is manifested by passing or unstable vomiting and vomiting.

With a deficiency of vitamin B1, both the central and peripheral nervous systems suffer, and polyneuropathy develops.

Korsakoff's syndrome, which occurs after bleeding, includes mental disturbances, as well as partial loss of memory. In this case, amnesia may develop. Damage to the ligaments between nerve cells can lead to a change in opinion, and people may be confused for a while. Delirium is a hallucinatory disorder. Often people are in a stupor, like stunned, at the station.

Diagnosis and treatment of Wernicke-Korsakoff syndrome

The patient needs to be examined by a neurologist or a psychiatrist. Differential diagnosis is carried out for such pathologies as schizophrenia, new brain development, psychosis and drug addiction.

Proper rejoicing will prevent the loss of amnesia. Injury to this Swedish assistance can lead to the death of the patient. For treatment, use vitamin B1, which is administered parenterally (subcutaneous, internal injections). Thiamin therapy is carried out until clinical improvement. Please remember that this drug, regardless of its innocence, can cause anaphylactic shock in a patient. Other vitamins of group B are also introduced: Pyridoxine, Cobalamin, Nicotinic acid.

Patients are also shown:

When you are tired, use anabolic steroids to gain body mass.
Carry out treatment for the main illness that caused this disorder: alcoholism, Melory-Weiss syndrome, vomiting.
Use antihypoxic drugs to protect cells during acid fasting: Mexidol, .
The angioprotector Actovegin improves blood circulation and blood rheology.
Nootropic drugs for memory preservation are being used: Noopept, Aniracetam.

Visnovok

Vitamin B1 is an important vitamin whose deficiency can lead to Wernicke encephalopathy and mental Korsakoff syndrome. The earlier the illness was revealed, the better the prognosis. Untimely assistance may result in disability and death. With Wernicke-Korsakoff encephalopathy, which has gone too far, there may be excessive development of cunning movements in the eyes, impaired memory.

Acute encephalopathy is caused by a deficiency of vitamin B1, which is necessary for adequate metabolism of cerebral cells. Gaye-Wernicke encephalopathy is characterized by three clinical syndromes: mixed ataxia, disorder of the cervical function and impaired integrative function of the central nervous system. Verification of the diagnosis is achieved by examining the anamnesis, assessing the neurological status and combining them with the data of EEG, REG, biochemical blood analysis, follow-up of the cerebrospinal region, MRI of the brain. Treatment is based on the emergency introduction and further treatment of vitamin B1, including psychotropic, antioxidant, nootropic, and anti-inflammatory pharmaceuticals.

Zagalnye Vidomosti

Gaye-Wernicke syndrome is named after the French doctor Gaye and the German neuropsychiatrist Wernicke. The first described the disease, calling it “diffuse encephalopathy”, the other - giving a description of a similar clinical picture under the name “superior acute polyencephalitis”, noting that it is based on ignition processes. Gaye-Wernicke encephalopathy increases significantly in people aged 30-50 years, most often in the period from 35 to 45 years. However, in the current literature on neurology, one can find single descriptions of the development of vcom syndrome up to 30 years ago. Although addiction to alcohol is not the only cause, most often Gaye-Wernicke syndrome arises from alcoholism itself, which is associated with acute alcoholic encephalopathy.

Causes of Gaye-Wernicke syndrome

Based on recent manifestations, Gaye-Wernick syndrome is caused by a severe deficiency of thiamine (vitamin B1) in the body. The remainder is a cofactor for several enzymes involved in various metabolic processes in the human body. As a result of B1 deficiency, biochemical reactions are caused by these enzymes. Finally, there is a decrease in the utilization of glucose by nerve cells, due to their energetic starvation and post-cellulitis accumulation of glutamate. Glutamate is an activator of ion channel receptors in cerebral neurons. This increased concentration leads to hyperactivation of the channels that transport calcium to the nerve tissue. Excess of intracellular calcium leads to the activation of a number of enzymes, which organize the structural elements of the cell, primarily mitochondria, and initiate apoptosis (self-renewal) of neurons.

Characteristic is the periventricular distribution of cerebral tissues in the sections III and IV of the sylvian aqueduct. The most important structures that suffer are the cerebral vermis and perineum, the vermis, and the mediodorsal nucleus of the thalamus. The remaining pathology is associated with memory disorder, which accompanies Gaye-Wernicke syndrome.

The cause of illness may be any pathological processes that lead to thiamine deficiency. For example, hypovitaminosis, illness with malabsorption syndrome, extreme fasting, inadequate parenteral nutrition, constant vomiting, SNID, helminthiasis, oncological illness, which leads to cancer exii, ta in. However, most seizures are associated with Gaye-Wernicke syndrome. The severity of alcohol abuse before the onset of the syndrome varies from 6 to 20 years, in women it can be as little as 3-4 years. As a rule, Gaye-Wernicke syndrome manifests itself in the third or other stages of alcoholism, when heavy drinking continues for months. In this case, 30-50% of patients already have a history of alcoholic psychosis.

Symptoms of Gaye-Wernicke syndrome

As a rule, Gaye-Wernicke syndrome debuts after a prodromal period, which lasts for an average of several years to months. In the prodrome, asthenia, anorexia with severe symptoms, instability of the pelvic floor (which can be associated with diarrhea), fatigue and vomiting, abdominal pain, sleep disturbances, swelling in the fingers, may occur. And in Lithuanian meats, decreased vision. In some cases, Gaye-Wernicke syndrome debuts without prodrome due to acute somatic or infectious pathology, withdrawal syndrome.

The characteristic triad of manifestation of acute Gaye-Wernick encephalopathy is considered: confusion of fluid, ataxia, and cervical disorders (ophthalmoplegia). However, this is avoided in less than 35% of patients. Most episodes indicate inability to concentrate, apathy, disorientation, lack of coherent thought, disorganization of reason and harmony. Since Gaye-Wernicke syndrome debuts in the context of withdrawal syndrome, there may be alcohol delirium, which is accompanied by psychomotor restlessness. Ataxia is expressed up to the stage of abasia – the inability to walk and stand on one’s own. It is mixed: cerebellar, vestibular and sensitive. The remainder is called polyneuropathy, the presence of which is found in 80% of cases. Eye disorders include squinting, horizontal nystagmus, drooping upper eyelids, discoordination of the eyeballs; at later stages – miosis.

When not treated, Gaie-Wernicke encephalopathy often results in coma and death. During the therapy that is carried out, progressive regression of the most common symptoms is avoided. We already know ophthalmoplegia. This can be achieved within a few years after administration of vitamin B1, in other cases – after 2-3 additions. For the presence of such dynamics, the diagnosis should be reviewed. Svidomosti problems are regressing even more. At this point, problems gradually arise from the acquisition of new information and memory impairment (fixation amnesia, memory loss), which leads to a clinical picture of Korsakoff syndrome.

In case of cervical disorders, half of the patients persistently retain horizontal nystagmus, which occurs when the gaze shifts. A similar vertical nystagmus can be observed for 2-4 months. The reversal development of ataxia and vestibular disorders can last for up to a month. In approximately 50% of patients, persistent residual ataxia persists, and walking becomes unsteady and smooth.

Diagnosis of Gaye-Wernicke syndrome

To make a diagnosis of “Guy-Wernicke syndrome,” a neurologist can rely on anamnesis, a characteristic clinical picture, and regression of symptoms during thiamine therapy. When looking around, one pays attention to the signs of chronic poor nutrition (low body weight, dry skin and decreased elasticity, deformation of the nails, etc.). In neurological status, there is a disorder of speed, mixed ataxia, ophthalmoplegia, polyneuropathy, signs of autonomic dysfunction (hyperhidrosis, tachycardia, arterial hypotension, orthostatic aps).

Biochemical blood analysis may indicate a decrease in transketolase activity and an increase in the concentration of pyruvate. After performing a lumbar puncture, examination of the cerebrospinal cord shows that it corresponds to the norm. If pleocytosis is detected and instead of protein over 1000 g/l, then think about the development of complications. A caloric test diagnoses the presence of practically symmetrical bilateral vestibular disorders.

In half of the patients, Gaye-Wernick syndrome is accompanied by generalized exaggerated symptoms of EEG. REG most often indicates a diffuse decrease in cerebral blood flow. CT scan of the brain does not register pathological changes in cerebral tissues. MRI of the brain makes it possible to detect hyperintense areas in the medial nuclei of the thalamus, mammillary bodies, walls of the third scutulum, reticular formation, gray ventricle, which is the source of sylvian water, dahu brain Higher concentration zones accumulate contrast, which must be injected during the hour of additional contrast during the hour of MRI. In overexposed areas, petechial hemorrhage and signs of cytotoxic plaque may appear.

Treatment and prognosis for Gaye-Wernicke syndrome

Gaye-Wernick syndrome is urgent. Required hospitalization and the earliest possible start of vitamin B1 therapy. Thiamin is administered internally dropwise two days a day, then switches to internal administration. In parallel with this, other vitamins are prescribed: B6, C, PP. Delirium is indicated before the use of barbamyl, chlorpromazine, diazepam, haloperidol, etc. psychotropic properties. As an antioxidant treatment, use cytoflavin infusion. If necessary, therapy is carried out with the participation of a psychiatrist or narcologist. Further, to improve mnestic functions, courses of nootropics (piracetam, gamma-aminobutyric acid, ginkgo extract) and pharmaceutical drugs (pentoxifyline, vinpocetine) are prescribed, and repeated courses of therapy are carried out foreign

Gaye-Wernicke syndrome has a serious prognosis. In 15-20% of cases hospitalized before hospitalization, the patient dies, most often due to liver failure or intercurrent infections (pulmonary tuberculosis, severe pneumonia, sepsis). Since Gaye-Wernicke encephalopathy is of alcoholic origin, it is prevented from transforming into Korsakoff psychosis, which is a persistent psychoorganic syndrome and is associated with chronic alcoholic encephalopathy.