Клинический случай неалкогольной энцефалопатии Вернике в позднем послеоперационном периоде

Энцефалопатия Вернике остается клинически значимым, но часто недооцененным послеоперационным осложнением, особенно на фоне роста неалкогольных форм заболевания. В настоящем наблюдении представлена неалкогольная форма энцефалопатии Вернике у 84-летней пациентки, перенесшей хирургическое лечение рака поперечной ободочной кишки с резекцией правой половины толстой кишки, выведение илеостомы и длительный курс парентерального питания. В послеоперационном периоде постепенно развились глазодвигательная дисфункция, мозжечковая атаксия и нарушение сознания. Диагноз установлен на основании клинической картины и характерных изменений по данным магнитно-резонансной томографии. Сопутствующие метаболические нарушения, включая гипокалиемию и метаболический алкалоз, при отсутствии выраженного лабораторного дефицита тиамина затрудняли раннюю диагностику. Назначение высокодозовой терапии тиамином привело к быстрой положительной динамике. Этот случай подчеркивает необходимость клинической настороженности в отношении неалкогольных форм энцефалопатии Вернике у хирургических пациентов с риском мальабсорбции и нутритивной недостаточности, а также значимость своевременной профилактики и расширения осведомленности о патогенезе и клинике заболевания в современной медицинской практике.

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