nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2015-4-27-32nnp-555Research ArticleCLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯAcute cerebellar ataxia in a young woman: Wernicke’s encephalopathy?Острая мозжечковая атаксия у молодой женщины: энцефалопатия Вернике?ДолговаС. Г.DolgovaS. G.

129110, Москва, ул. Щепкина, 61/2

61/2 Shchepkin St., Moscow 129110

КотовА. С.KotovA. S.

129110, Москва, ул. Щепкина, 61/2

61/2 Shchepkin St., Moscow 129110

alex-013@yandex.ruМатюкЮ. В.MatyukYu. V.

129110, Москва, ул. Щепкина, 61/2

61/2 Shchepkin St., Moscow 129110

БорисоваМ. Н.BorisovaM. N.

129110, Москва, ул. Щепкина, 61/2

61/2 Shchepkin St., Moscow 129110

ПантелееваМ. В.PanteleevaM. V.

129110, Москва, ул. Щепкина, 61/2

61/2 Shchepkin St., Moscow 129110

ШаталинА. В.ShatalinA. V.

129110, Москва, ул. Щепкина, 61/2

61/2 Shchepkin St., Moscow 129110

ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияM.F. Vladimirskiy Moscow Regional Clinical Research InstituteRussian Federation201514012016742732Copyright © Dolgova S.G., Kotov A.S., Matyuk Y.V., Borisova M.N., Panteleeva M.V., Shatalin A.V., 20162016Долгова С.Г., Котов А.С., Матюк Ю.В., Борисова М.Н., Пантелеева М.В., Шаталин А.В.Dolgova S.G., Kotov A.S., Matyuk Y.V., Borisova M.N., Panteleeva M.V., Shatalin A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/555

Wernicke’s encephalopathy (WE) is a rare but severe neurological syndrome caused by thiamine deficiency. According to the data of autopsy studies, the prevalence of WE in the general population varies from 0.4 to 2.8 per 100,000 population; the disease occurs many times more frequently in alcohol abusers than in people who lead a healthy lifestyle. These studies also showed that most cases of WE were diagnosed postmortem; less than 20% of patients with the disease were diagnosed in life. A healthy adult requires 1–2 mg of thiamine daily, depending on the carbohydrate intake. Body’s reserves of thiamine are only 30–50 mg so any malnutrition condition lasting more than 3–4 weeks can cause complete depletion of the vitamin’s stores. Classically, WE is characterized by the sudden onset of a typical triad of symptoms: an altered mental state, ophthalmoplegia, and ataxia. However, this clinical picture can be seen in only one-third of patients. The onset of the disease may sometimes look completely different: heart failure with hypotension and tachycardia; gastrointestinal symptoms (abdominal pain and nausea); hypothermia due to the involvement of the posterior hypothalamus; deafness affecting the thalamus; epileptic seizures in case of enhanced activity of the glutamatergic system.

The paper describes a clinical case of acute cerebellar ataxia that is apparently caused by Wernicke’s encephalopathy in a young woman.

Энцефалопатия Вернике (ЭВ) представляет собой редкий, но тяжело протекающий неврологический синдром, причиной которого является дефицит тиамина. По данным аутопсий, распространенность ЭВ в общей популяции варьирует от 0,4 до 2,8 на 100 тыс. населения, причем у людей, злоупотребляющих алкоголем, заболевание встречается в разы чаще, чем у сторонников здорового образа жизни. Эти исследования также показали, что ЭВ в большинстве случаев диагностируется посмертно, при жизни диагноз был поставлен менее чем в 20% случаев. Ежедневная потребность взрослого человека в тиамине достигает в зависимости от количества потребляемых углеводов 1–2 мг/сут. Запасы витамина в организме составляют всего 30–50 мг, поэтому любое со- стояние, вызывающее недостаточное поступление тиамина и длящееся более 3–4 нед, может вызвать полное истощение витаминного резерва. Классическим дебютом ЭВ считается внезапное появление типичной триады симптомов: изменение психического статуса, офтальмоплегия и атаксия. Однако такая клиническая картина встречается лишь у трети пациентов. Иногда начало болезни может выглядеть совершенно иначе: сердечная недостаточность с артериальной гипотензией и тахикардией, гастроинтестинальная симптоматика (боль в животе и тошнота), гипотермия в связи с поражением задней доли гипоталамуса, глухота при вовлечении таламуса, эпилептические приступы в случае повышения активности глутаматергической системы.

Представлено клиническое наблюдение острой мозжечковой атаксии, очевидно, обусловленной ЭВ, у молодой женщины.

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The authors declare that there are no conflicts of interest present.