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由于维生素B12缺乏引起的急性精神障碍,全胃切除术后八年
Takayoshi Tsubaki1, Mitsuhiro Morikawa2, Takanori Goi2
1Cancer Care Promotion Center, University of Fukui Hospital, Fukui, JPN.
Cureus
|October 4, 2024
概括
维生素B12缺乏会导致精神疾病,尤其是在胃切除术后. 及时补充B12可快速改善混合性贫血患者的症状,突出显示在胃切除术后的患者需要考虑这一点.
科学领域:
- 神经学 神经学
- 胃肠病学 胃肠病学
- 血液学 血液学 血液学
背景情况:
- 维生素B12缺乏可以表现为各种疾病,包括精神疾病,而不仅仅是巨细胞性贫血.
- 由于各种原因和异常呈现,诊断可能具有挑战性.
- 胃外科手术,特别是全胃切除术,显著损害了维生素B12的吸收.
研究的目的:
- 报告一个病例的精神疾病二次的维生素B12缺乏在一个患者的病史的全胃切除术.
- 强调在胃切除术后出现神经或精神症状的患者中考虑维生素B12缺乏的重要性.
- 为了突出诊断挑战,当巨细胞贫血缺席.
主要方法:
- 一个37岁的女性在全胃切除术8年后出现了急性精神症状的病例报告.
- 最初的诊断工作包括神经成像,脑脊液分析,脑电图和血液检查.
- 治疗包括经验性静脉注射维生素替代疗法,随后是特定的维生素B12补充剂.
主要成果:
- 患者表现出精神障碍,没有典型的巨细胞贫血;血清铁也下降了 (混合贫血).
- 神经成像和脑液分析没有显著的结果;排除了疹脑炎.
- 在补充维生素B12后,精神症状迅速消失.
- 以后证实了维生素B12水平极低的情况.
- 患者的病情归因于维生素B12吸收受损,这是由于胃切除术后的内在因子缺乏.
结论:
- 维生素B12缺乏,即使没有宏细胞性贫血,也可能导致严重的精神疾病.
- 整体胃切除术是维生素B12缺乏和随后的神经精神疾病并发症的重要危险因素.
- 在胃切除术后的精神状态改变的患者中,对维生素B12缺乏的早期考虑和及时治疗至关重要.
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