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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.50 no.3 São Paulo Sept. 1992

http://dx.doi.org/10.1590/S0004-282X1992000300012 

Coma and death in unrecognized wernicke's encephalopathy an autopsy study

 

Coma e morte na encefalopatia de Wernioke: estudo necroscópico

 

 

Marco Aurélio Lana-peixotoI; Eustáquio Claret Dos SantosII; José Eymard H. PittellaIII

IAssociate Professor of Neurology
IINeurologist
IIIFull-Professor. Department of Neurology (Dr. Lana-Peixoto) and Pathology (Dr. PittelDa), Federal University of Minas Gerais

 

 


SUMMARY

Eleven out of 36 autopsied cases of Wernicke's encephalopathy had developed coma. None of these patients had the diagnosis during life. There were six men and five women with ages ranging from 36 to 50 years (mean 36.6). Seven of these patients were heavy drinkers, three exhibited signs of severe malnutrition, whereas one was being evaluated for a disseminated gastric cancer and one was in treatment of hyperemesis gravidarum. Two patients were brought to the hospital after found unconscious at home. Neuropatholo-gical examination disclosed gross changes in the mammillary bodies in eight cases and microscopic changes in all cases. In one case there was atrophy of the anterior superior part of the vermis. Petechial hemorrhages were observed particularly in the walls of the third ventricle. Microscopically there were in addition to hemorrhages, glial proliferation, endothelial hypertrophy and necrosis of nerve cells and myelin. Central pontine myelmolysis was observed in one case. Wernicke's encephalopathy is a clinically underdiagnosed condition. Coma may mask its classical clinical picture or even be the sole manifestation. Although coma points to a poor outlook it may be reversed by thiamine administration. Any patient with Coma of unknown etiology should be given parenteral thiamine.

Key words: Wernicke's encephalopathy, coma, clinical diagnosis, neuropathology.


RESUMO

Numa série de 36 casos de encefalopatia de Wernicke autopsiados, 11 haviam desenvolvido coma. Em nenhum desses pacientes comatosos o diagnóstico foi estabelecido durante a vida. Seis desses pacientes eram homens e 5 mulheres, com idades entre 26 a 50 anos (média de 36,6). História de alcoolismo crônico foi positiva em 7 casos, sinais de desnutrição grave ocorreram em 3; uma paciente (apresentava câncer gástrico e uma, hiper emese gravídica. Dois pacientes foram admitidos ao hospital após terem sido encontrados em coma em suas residências. O exame neuropatológieo revelou alterações macroscópicas nos corpos mamilares em 8 casos — atrofia, descoloração e espongiose. Atrofia da porção anterior e superior do vermis do cerebelo foi observada em um caso. Era 5 casos havia hemorragias petequiais no diencéfalo, principalmente próximas às paredes do terceiro ventrículo. A microscopia revelou além das hemorragias, proliferação glial, hipertrofia do endotélio vascular e necrose de neurônios e mielina. Mielinólise pontina central ocorreu em um paciente. A encefalopatia de Wernicke é pouco diagnosticada clinicamente. O coma pode mascarar as outras manifestações clínicas da doença ou pode constituir sua única manifestação. Embora seja um sinal de mau prognóstico, o coma pode ser revertido pela administração de tiamina. É enfatizado que todo paciente em coma de causa não estabelecida deve receber altas doses de tiamina.

Palavras-chave: encefalopatia de Wernicke, coma, diagnóstico clínico, neuropa-tologia.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Dr. Marco Aurélio Lana-Peixoto — Departamento de Neurologia, Instituto Hilton Rocha — Av. Anel dm Serra 1355 - 30210 Belo Horizonte MG - Brasil.