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Case No. 446
2017-06-01~2017-06-30
출제자 : 이경식
Hit : 344
| Period | 2017-06-01~2017-06-30 |
|---|---|
| Diagnosis | Wernicke encephalopathy (atypical feature) |
| Clinical information | 내원 3일전부터 의식저하 발생한 80세 여자환자의 MRI 영상입니다. 가능한 진단은? |
| Discussion | C. difficile infection으로 한달 간 intravenous TPN하던 중 발생 Thiamine-deficient membranes are unable to maintain osmotic gradients, resulting in the swelling of both intra-and extracellular spaces, that is typically occurs in selective, vulnerable regions within 2-3 weeks. Classically, the bilateral medial dorsal thalamic nuclei are affected in upwards of 100% of patients, while the superior vermis of the cerebellum, is involved in about a third of cases. Other affected areas include the periaqueductal region, the pontine tegmentum, the reticular formation of the midbrain, the posterior corpora quadrigemina, and the cerebral cortex. In the periventricular regions, not only is the blood-brain barrier physiologically less tight, but a high rate of thiamine-related glucose and oxidative metabolism also occur. J Neurocrit Care 2013;6:43-46 |
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