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Abstract: Patients with amnesia may attempt to fill memory gaps with fiction. Patients may experience selective amnesia, unaffected by long-standing and extremely ingrained memories, usually associated with Wernicke’s encephalopathy due to long-term alcohol use, which usually manifests as significant short-term memory impairment and milder long-term memory involvement, as was the case with the patient in this case, who was seen and treated with medication to bring about symptom relief.
[Basic information] Male, 38 years old
Type of disease】Amnesia
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
Treatment plan】Medication (vitamin B1 injection + methylcobalamin tablets + liver protection tablets)
Treatment period】9 days of hospitalization
Effectiveness of treatment】Symptoms of selective memory disorder were relieved
I. Initial interview
The patient developed selective memory disorder 3 days before admission without any obvious cause, manifesting as inability to recall the name of his residence, inability to remember what happened at one time, inability to remember the name of a specific classmate but still recognizing other classmates, misremembering his own phone number but firmly believing it to be right, often saying things that do not exist, movable limbs, no obstruction to left and right, no dizziness and nausea The patient’s family brought the patient to our emergency room late at night, and no bleeding foci were seen on head CT. We learned that the patient had been an alcoholic for many years.
II. Treatment history
The patient was admitted to the hospital with a clear consciousness, high emotion, blood pressure of 140/90 mmHg, heart rate of 95 beats/min, selective memory impairment, bilateral pupils of about 3.0 mm in diameter, no abnormal muscle tone in the extremities, lack of cooperation in ataxic motor examination, negative pathological signs in both lower extremities, abnormal signals in the third ventricle, around the midbrain aqueduct, bilateral thalamus and papillae on head MRI, and DWI The sequence was seen to be locally diffuse and slightly high signal, and the diagnosis of amnesia was made after the examination results. Subsequently, the patient was given vitamin B1 injection intravenously, methylcobalamin tablets orally, and some symptomatic supportive treatment. As the patient had liver function damage, he was given liver-protective tablets for liver protection, etc. The overall medication was administered for 9 days.
III. Treatment effect
After 9 days of treatment in our hospital, the patient’s condition was in remission, the patient’s selective memory loss was relieved, the fictitious fantasy symptoms disappeared at the time of discharge, and good efficacy was achieved for distant memory, for digital memory still had deficits and needed to recover slowly. Since the patient’s liver function was abnormal after admission, which was considered to be greatly related to alcohol consumption, a gastroenterology consultation was suggested and liver-protective treatment was given, and the abnormal liver function was restored at discharge.
IV. Notes
I was very pleased to see the patient discharged after his symptoms improved. The patient had a serious vitamin B1 deficiency due to long-term alcohol consumption, which led to selective amnesia, and the more typical manifestation was apathy and lack of introspection of the disease, sometimes with fictitious, so after discharge, it is still recommended that the family should also pay close attention to the patient’s status in the later rehabilitation care, and if the patient has uncomfortable symptoms or the condition flares up again, he must seek medical treatment in time. In addition, after discharge, attention should be paid to abstaining from alcohol, balanced nutrition, eating more vitamin-rich foods such as vegetables and fruits, and maintaining a reasonable and healthy diet.
V. Personal insight
Wernicke’s encephalopathy mainly manifests as sudden onset of neurological dysfunction, such as extraocular muscle paralysis, mental abnormalities, ataxia, etc. Amnesia is also common. Ataxia is mainly in the trunk and lower limbs, with difficulty in standing and walking, CT shows bilateral hypo- or high-density lesions in the thalamus and brainstem, and MRI is more sensitive for early diagnosis. If not treated in time, the natural course of the disease may continue to progress, and if the patient develops symptoms such as coma, shock and cardiovascular failure, it often suggests a poor prognosis, so timely treatment is needed, and usually the treatment can be as effective as the patient can achieve good results.