r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2024-29-4-16-26r-n-j-603Research ArticleОБЗОРЫREVIEWSЭнцефалопатия ВерникеWernicke's Encephalopathyhttps://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

Пермь 

Perm

aleksey.kulesh@gmail.comДеминД. А.DeminD. A.

Астрахань

Astrakhan

КайлеваН. А.KailevaN. A.

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Perm

Пермский государственный медицинский университет им. академика Е.А. Вагнера ; Городская клиническая больница № 4РоссияPerm State Medical University named after. Academician E.A. Wagner ; City Clinical Hospital No. 4Russian FederationФедеральный центр сердечно-сосудистой хирургии Минздрава РоссииРоссияFederal Center for Cardiovascular SurgeryRussian FederationГородская клиническая больница № 4РоссияCity Clinical Hospital No. 4Russian Federation2024051120242941626Copyright © Кулеш А.А., Демин Д.А., Кайлева Н.А., 20242024Кулеш А.А., Демин Д.А., Кайлева Н.А.Kulesh A.A., Demin D.A., Kaileva N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/603

Энцефалопатия Вернике − тиамин-дефицитарное состояние, в основе которого помимо злоупотребления алкоголем лежит широкий спектр соматических причин. У большинства пациентов в дебюте заболевания отсутствует классическая клиническая триада — глазодвигательные нарушения, атаксия и когнитивные расстройства, что затрудняет своевременную диагностику. Заболевание может манифестировать головокружением, неустойчивостью, двоением или когнитивными расстройствами. Ключевые клинические проявления включают: симметричный индуцированный взором нистагм, туловищную атаксию, двухсторонний парез отводящих нервов, межъядерную офтальмоплегию, двухстороннее снижение вестибулоокулярного рефлекса, а также антероградную амнезию. Для постановки диагноза обязательно наличие состояния, приводящего к дефициту тиамина. Диагноз подтверждается МРТ, однако уже при клиническом подозрении на энцефалопатию Вернике необходимо инициировать парентеральную терапию тиамином в адекватной дозе. При своевременном лечении заболевание характеризуется хорошим прогнозом.

Wernicke encephalopathy is a thiamine deficiency condition that has a wide range of somatic causes in addition to alcohol abuse. Most patients do not have the classical clinical triad — oculomotor dysfunction, ataxia and cognitive impairment at the onset of the disease, which makes timely diagnosis difficult. The disease may manifest as dizziness, unsteadiness, double vision, or cognitive impairment. Key clinical manifestations include symmetrical gaze-evoked nystagmus, truncal ataxia, bilateral abducens paresis, internuclear ophthalmoplegia, bilateral vestibular-ocular reflex reduction, and anterograde amnesia. To make a diagnosis, the presence of a condition leading to thiamine deficiency is required. The diagnosis is confirmed by MRI, but even with clinical suspicion of Wernicke encephalopathy, it is necessary to initiate parenteral therapy with thiamine in an adequate dose. With timely treatment, the disease has a good prognosis.

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