Wernicke脳症の臨床・神経病理学的研究 : 特に下オリーブ核病変の特徴について

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In Japan, there have been few clinicopathologic studies of many cases of Wernicke's encephalopathy (WE) from a single medical institution. We analyzed 12 cases (patients were 8 men and 4 women; age range, 28-69 years; mean age, 56 years) of pathologically confirmed WE identified from 3, 045 brain autopsy files. Clinical findings were obtained from clinical records, and we paid particular attention to the neuropathology of the inferior olivary nucleus (ION) in addition to the thalamus, mamillary body (MB), and cerebellum. Background disorders included chronic alcoholism (n=3), malignancy (n=5), and other diseases (n=4). WE was suspected prior to death in 2 cases according to brain magnetic resonance (MR) findings. Punctuate macroscopic hemorrhages or atrophy in the MB and areas adjacent to the 3rd and 4th ventricles (3rd/4th area) and midbrain aqueduct were noted to various degrees in 10 cases. Eosinophilic and atrophic degeneration of the ION that differed from that of the MB and 3rd/4th area was observed in all 12 cases and in particular in 6 severe cases. Degeneration of the ION correlated well with that of the medial nucleus of thalamus but not of the cerebellum. Severe changes in the ION and MB were associated with increased psychosis. The frequency of WE in Japan appears to be less than 0.39% (12/3, 045 autopsy files). WE arose more often on a background of malignant disease than of other conditions. Few typical WE clinical manifestations suggest difficulty in early clinical diagnosis but the importance of diagnostic brain MR imaging. Extensive neuropathology of the ION has not been recognized hitherto. Changes in the ION and thalamus were identical and did not necessarily accord with cerebellar degeneration. Neuropathologic changes in the ION due to thiamine deficiency may differ from those in the MB and 3rd/4th area.
愛知医科大学の論文
2006-12-15

Wernicke脳症の臨床・神経病理学的研究 : 特に下オリーブ核病変の特徴について

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