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BRAIN and NERVE Volume 61, Issue 9 （September 2009）

BRAIN and NERVE 61巻9号（2009年9月発行）

Japanese English

症例報告

Wernicke脳症，亜急性連合性脊髄変性症，衝心脚気をきたしたビタミンB₁，B₁₂，葉酸欠乏症の1例 A Case of Wernicke's Encephalopathy and Subacute Combined Degeneration of the Spinal Cord due to Vitamin Deficiency Showing Changes in the Bilateral Corpus Striatum and Cardiac Arrest due to Beriberi Heart Disease 石河朝子 ¹ , 田口丈士 ¹ , 竹口将文 ¹ , 齊藤博彦 ¹ , 南里和紀 ¹ Tomoko Ishiko ¹ , Takeshi Taguchi ¹ , Masafumi Takeguchi ¹ , Hirohiko Saito ¹ , Kazunori Nanri ¹ ¹東京医科大学八王子医療センター神経内科 ¹Department of Neurology,Tokyo Medical University Hachioji Medical Center キーワード： vitamin deficiency , beriberi heart disease , Wernicke's encephalopathy combined degeneration of the spinal cord Keyword: vitamin deficiency , beriberi heart disease , Wernicke's encephalopathy combined degeneration of the spinal cord pp.1069-1073

発行日 2009年9月1日 Published Date 2009/9/1

DOI https://doi.org/10.11477/mf.1416100557

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参考文献 Reference

はじめに

　ビタミンは生命維持に必須な物質であるが，その多くは生体内で合成されない。栄養事情が良好なわが国ではビタミン欠乏などの栄養障害は稀と考えられているが，高齢者，糖尿病患者，アルコール多飲者や偏った栄養摂取者など潜在的な栄養障害の患者は存在し，しばしば臨床の現場でビタミン欠乏症状を呈する患者を経験する。今回われわれは偏食が原因となったビタミンB₁・B₁₂，葉酸欠乏によって，多彩な神経症状，衝心脚気をきたし，またMRIで両側線条体病変を呈した症例を経験したので報告する。

Abstract

　A 52-year-old woman was admitted to the hospital because of appetite loss, unsteadiness, psychogenic symptoms, ataxia, and consciousness disturbance as a result of the ingestion of a diet restricted to only carbohydrates for a long term.　Laboratory examination indicated the presence of pancytopenia with macrocytic anemia; further, decreased vitamin B₁ and B₁₂ levels were detected in her serum.　Magnetic resonance imaging fluid attenuated inversion recovery (FLAIR), revealed high-signal intensity in the bilateral corpus striatum, third ventricle circumference, and cerebellar cortex.

　Thereafter, she received drip infusion that did not include vitamin B₁ or B₁₂ and subsequently suffered a cardiac arrest due to the aggravation of cardiac insufficiency; consequently, she was transferred to our hospital.

　Upon admission the patient was diagnosed to have obvious cardiomegaly with pleural effusion; further, a negative T-wave was obtained on the electrocardiogram.　A diagnosis of beriberi heart disease was made because of thiamine deficiency.　She was treated by thiamine administration, following which the cardiac symptoms improved immediately.

　Various neurological symptoms caused by encephalopathy, peripheral neuropathy and subacute combined spinal cord degeneration improved by treatment with thiamine and cyanocobalamine administration; however, some of these symptoms still remained.　General awareness of the fact that neurological symptoms can be caused by vitamin deficiency is essential.

(Received: November 4,2008,Accepted: April 13,2009)