Encephalopathy Wörnicke– acute or subacute damage to the midbrain and hypothalamus due to vitamin B deficiency. The reason for the deficiency are dietary disorders caused by alcoholism, beriberi, gastrointestinal diseases, indomitable vomiting of pregnant women, vomiting in case of poisoning with digitalis products. Observed in chronic hemodialysis. They are classified as organic-toxic psychoses, often combined with Korsakoff’s syndrome. It occurs acutely, subacutely or chronically. Pathogenesis. It is characterized by a decrease in the number of neurons, demyelination and gliosis of the area of the periventricular gray matter. The most frequently involved areas are the medial hypothalamus, mastoid bodies, the cerebellar vermis and the nuclei of the III, VI and VIII cranial nerves. Clinical picture. Considerable dynamism and instability of a symptomatology are characteristic;
- The classic symptom complex is a triad of symptoms: ophthalmoplegia, ataxia, mental disorder.
- The most common symptoms are nystagmus, VI cranial nerve palsy, and horizontal or combined horizontal-vertical gaze palsy.
- More rare symptoms: pupillary disorders (strabismus, miosis, anisocoria), hyperkinesis (trembling of the lower jaw, myoclonus, choreoathetosis), changes in muscle tone (dystonia), autonomic disorders (decrease in body temperature, tachycardia, hyperhidrosis, etc.). Perhaps the development of violations of wakefulness and consciousness with progression to coma.
- In peripheral blood – macrocytic anemia
- In CSF, a slight increase in protein content (