Reviewed by 양깡, MD
관련 뉴스 : http://www.medicalnewstoday.com/healthnews.php?newsid=65169
비만 교정 수술은 최근 비만이 성인병의 큰 원인이라는 사실 때문만 아니라 미용을 위해서 많이 하고 있습니다. 이러한 비만 수술은 위절제를 통해 하는 경우가 많습니다. 이런 비만 수술을 시행한 뒤에 4주에서 12주후 특히 젊은 여성에 있어서 신경 장애 (베르니케뇌병증, Wernicke encephalopathy)가 생긴다는 논문이 Neurology에 기고 되었습니다. 비전형적인 신경학적 양상을 보이며 임상적인 양상으로 진단내릴 수 있고 방사선학적으로는 특별한 소견이 보이지 않는다고 합니다.
아직 이 논문만으로 비만 수술이 위험하다고 결론 내리고 무조건 피하기에는 부족한 면이 있습니다. 후향적 연구의 단점인데요, 앞으로 전향적 연구가 뒤따라야 할 것입니다. 후향적 연구란 과거의 자료를 토대로 연구한 것입니다. 눈 여겨지는 것은 과거 연구자료 검색에 Medline 뿐 아니라 google도 있군요.
원인으로 생각되는 수술후 thiamine 보충 요법이 효과를 거둘지 연구 결과가 주목됩니다.
[#M_논문 초록 보기|논문 초록 |
Wernicke encephalopathy after obesity surgery
From the Section on General Internal Medicine, Department of
Internal Medicine, Wake Forest University Health Sciences,
Winston-Salem, NC (S.S.); MPH Program, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD (S.S.); and
Neurosciences Program, University of Iowa, Iowa City, IA (A.K.).
Address correspondence and reprint requests to Dr. Sonal Singh,
Department of Internal Medicine, Wake Forest University Health
Sciences, Medical Center Boulevard, Winston-Salem, NC 27157; e-mail: sosingh@wfubmc.edu
Objective: To characterize the clinical features,
risk factors, radiographic findings, and prognosis of Wernicke
encephalopathy after bariatric surgery.
Methods: We performed a systematic review of
MEDLINE, Embase, Ovid, ISI (Science Citation Index), and Google Scholar
for case reports, case series, or cohort studies of Wernicke
encephalopathy after bariatric surgery.
Results: We found 32 cases (27 of whom were women)
reported, from 2 weeks to 18 months after the procedure. Most patients
had vomiting as a risk factor (n = 25) and presented with the triad of
Wernicke encephalopathy (confusion, ataxia, and nystagmus; n = 21).
Optic neuropathy, papilledema, deafness, seizures, asterixis, weakness,
and sensory and motor neuropathy were also reported. Characteristic
radiographic findings were hyperintense signals in the periaqueductal
gray area and dorsal medial nucleus of the thalamus; radiographs were
normal in 15 patients. One series from Brazil reported 4 patients
(among 50 patients) with Wernicke encephalopathy; all presented with
vomiting and concomitant peripheral neuropathy at a median of 2.5
months (1.5 to 3 months) after bariatric surgery. Another series
identified 2 of 23 patients (both women) with Wernicke encephalopathy
after bariatric surgery.
Conclusion: Wernicke encephalopathy after bariatric
surgery usually occurs between 4 and 12 weeks postoperatively,
especially in young women with vomiting. Atypical neurologic features
are common. The diagnosis is mainly clinical, because radiographic
findings are normal in some patients. Prospective studies to determine
the prevalence of this problem and protocols for preventive thiamine
supplementation need evaluation.