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Wernicke's encephalopathy or now often Wernicke's disease refers to the presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vitamin B1). The condition is part of a larger group of diseases related to thiamine insufficiency, including beriberi in all its forms, and Korsakoff syndrome. When Wernicke's encephalopathy occurs simultaneously with Korsakoff syndrome it is known as Wernicke–Korsakoff syndrome.〔 Classically, Wernicke's encephalopathy is characterised by the triad ophthalmoplegia, ataxia, and confusion. However, only 10% of patients exhibit all three features, and other symptoms may also be present. While it is commonly regarded as a condition peculiar to malnourished people with alcohol misuse, a variety of diseases can lead to Wernicke's encephalopathy.〔〔 Wernicke's encephalopathy (WE) is treated with thiamine supplementation, which can lead to improvement of the symptoms and often complete resolution, particularly in those where alcohol misuse is not the underlying cause. Often other nutrients also need to be replaced, depending on the cause. Wernicke's encephalopathy may be present in the general population with a prevalence of around 2%, and is considered underdiagnosed; probably, many cases are in patients who do not have symptoms presumed to be associated with WE. ==Signs and symptoms== The classic triad of symptoms found in Wernicke's encephalopathy is: *ophthalmoplegia (later expanded to other eye movement abnormalities, most commonly affecting the lateral rectus〔 or any eye sign). *ataxia (later expanded to imbalance or any cerebellar signs) *confusion (later expanded to other mental changes. Has 82% incidence in diagnosis cases) However, in actuality, only a small percentage of patients experience all three symptoms,〔 and the full triad occurs more frequently among those who have overused alcohol. Also a much more diverse range of symptoms has been found in patients with this condition, including: *amblyopia, pupillary changes, retinal hemorrhage, papilledema, impaired vision and hearing, vision loss〔 *hearing loss, *fatigability, apathy, irritability, drowsiness, psycho and/or motor slowing 〔 *dysphagia,〔Tratado de Neurología, Codina Puiggros, pág. 823 y 824. ed.1994.〕 blush, sleep apnea, epilepsy and stupor *lactic acidosis *memory impairment,〔 amnesia, depression, psychosis * hypothermia, polyneuropathy, hyperhidrosis.〔〔Biller José. The Interface of Neurology and Internal Medicine. 2008. Lippincott Williams & Wilkins Ed.〕 Although hypothermia is usually diagnosed with a body temperature of 35 °C / 95° Fahrenheit, or less, incipient cooling caused by deregulation in the CNS, needs to be monitored because it can promote the development of an infection.〔 The patient may report feeling cold, followed by mild chills, cold skin, moderate pallor, tachycardia, hypertension, tremor or piloerection. External warming techniques are advised to prevent hypothermia. Among the frequently altered functions are the cardio circulatory. There may be tachycardia, dyspnea, chest pain, orthostatic hypotension, changes in heart rate and blood pressure. The lack of thiamine sometimes affects other major energy consumers, the myocardium, and also patients may have developed cardiomegaly. Heart failure with lactic acidosis syndrome has been observed. Cardiac abnormalities are an aspect of the WE, which was not included in the traditional approach,〔〔Zarranz, Juan J. (2007). Neurologia. (4a ed. ed.). Madrid, España: Harcourt Brace De Espana Sa. pp. 821 (Spanish.). ISBN 8480862289.〕 and are not classified as a separate disease. Infections have been pointed out as one of the most frequent triggers of death in WE.〔〔 Furthermore, infections are usually present in pediatric cases.〔 In the last stage others symptoms may occur: hyperthermia, increased muscle tone, spastic paralysis, choreic dyskinesias and coma. Because of the frequent involvement of heart, eyes and peripheral nervous system, several authors prefer to call it Wernicke disease rather than simply encephalopathy.〔〔 Early symptoms are nonspecific,〔〔Merk Manuals.http://www.merckmanuals.com/professional/nutritional_disorders/vitamin_deficiency_dependency_and_toxicity/thiamin.html?qt=wernicke%20encephalopathy&alt=sh〕 and it has been stated that WE may present nonspecific findings. In Wernicke Korsakoff’s syndrome some single symptoms are present in about one-third.〔Wernicke Korsakoff’s syndrome. Page 48.http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/2C3FC9166082567DCA257260007F81F8/$File/alcprobguide.pdf〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Wernicke's encephalopathy」の詳細全文を読む スポンサード リンク
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