uzspbgmuУчёные записки Первого Санкт-Петербургского государственного медицинского университета имени академика И. П. ПавловаThe Scientific Notes of the Pavlov University1607-41812541-8807Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1607-4181-2025-32-2-71-84uzspbgmu-1131Research ArticleОРИГИНАЛЬНЫЕ РАБОТЫORIGINAL PAPERSЭнцефалопатия Вернике в клинике трансплантации костного мозга: диагностические и терапевтические аспекты для гематологов, неврологов, диетологовWernicke encephalopathy in the bone marrow transplantation clinic: diagnostic and therapeutic aspects for hematologists, neurologists, nutritionistshttps://orcid.org/0000-0001-8699-2482ПолушинА. Ю.PolushinA. Yu.

Полушин Алексей Юрьевич, кандидат медицинских наук, врач-невролог, доцент, руководитель Научно-клинического центра трансплантации и клеточной терапии при аутоиммунных и нейродегенеративных заболеваниях, доцент кафедры неврологии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Polushin Alexey Yu., Cand. Sci. (Med.), Neurologist, Associate Professor, Chief of the Scientific and Clinical Center for Transplantation and Cell Therapy in Autoimmune and Neurodegenerative Diseases, Associate Professor of the Department of Neurology

6-8, L’va Tolstogo str., Saint Petersburg, 197022

alexpolushin@yandex.ruhttps://orcid.org/0000-0001-6114-3214КучерМ. А.KucherM. A.

Кучер Максим Анатольевич, доктор медицинских наук, руководитель отдела клинического питания НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, доцент кафедры гематологии, трансфузиологии и трансплантологии с курсом детской онкологии им. проф. Б. В. Афанасьева

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Kucher Maxim A., Dr. Sci. (Med.), Head of Clinical Nutrition Department, Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, Associate Professor of the Department of Hematology, Transfusiology and Transplantology with the Course in Pediatric Oncology

6-8, L’va Tolstogo str., Saint Petersburg, 197022

https://orcid.org/0000-0003-1955-1032СкибаЯ. Б.SkibaYa. B.

Скиба Ярослав Богданович, кандидат медицинских наук, врач-невролог клиники, научный сотрудник НИЛ нейроонкологии и аутоиммунных заболеваний НИИ ДОГиТ им. Р. М. Горбачевой

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Skiba Yaroslav B., Cand. Sci. (Med.), Neurologist of the Clinic, Research Fellow of the Research Laboratory of Neuro-Oncology and Autoimmune Diseases, Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation

6-8, L’va Tolstogo str., Saint Petersburg, 197022

https://orcid.org/0000-0002-0215-4623ВладовскаяМ. Д.VladovskayaM. D.

Владовская Мария Давидовна, кандидат медицинских наук, зав. отделением госпитальных регистров клиники НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, старший научный сотрудник научно-исследовательской лабораторией нейроонкологии и аутоиммунных заболеваний НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 

Vladovskaya Maria D., Cand. Sci. (Med.), Head of the Department of Hospital Registers of the Clinic of Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, Senior Research Fellow of the Research Laboratory of Neuro-Oncology and Autoimmune Diseases of Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation

6-8, L’va Tolstogo str., Saint Petersburg, 197022

Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. ПавловаРоссияPavlov UniversityRussian Federation2025160920253227184Copyright © Полушин А.Ю., Кучер М.А., Скиба Я.Б., Владовская М.Д., 20252025Полушин А.Ю., Кучер М.А., Скиба Я.Б., Владовская М.Д.Polushin A.Y., Kucher M.A., Skiba Y.B., Vladovskaya M.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sci-notes.ru/jour/article/view/1131

Введение. Трансплантация гемопоэтических стволовых клеток (ТГСК) – сложный метод, характеризующийся высокодозным лекарственным воздействием, длительным периодом панцитопении и применения иммуносупрессоров, что может быть причиной нежелательных токсических осложнений, в том числе с вовлечением нервной системы. Наиболее частыми осложнениями с поражением нервной системы в онкогематологии являются токсические реакции, инфекционные, цереброваскулярные заболевания, дисметаболические состояния. Среди дефицитных состояний, как правило, в результате дефицита тиамина на фоне нарушенного аппетита и синдрома желудочно-кишечной токсичности, можно ожидать развития энцефалопатии Вернике (ЭВ).Цель – детализация факторов риска возникновения ЭВ в онкогематологии и повышение настороженности среди врачей различных специальностей относительно вероятности развития данного осложнения при проведении цитостатической, иммунной терапии и ТГСК.Методы и материалы. В рамках ретро- и проспективного исследования проанализирована трансплантационная активность НИИ ДОГиТ им. Р. М. Горбачевой с 2018 по 2024 гг. За исследуемый период выполнена 2081 ТГСК, среди которых выявлено 5 случаев ЭВ.Результаты. Представлены факторы риска ЭВ в исследуемой группе пациентов. Собраны данные по дифференциальной диагностике ЭВ с другими заболеваниями, характерными для посттрансплантационного периода алло-ТГСК. Проанализированы данные литературы применительно к частоте выявления, клиническим, нейровизуализационным, морфологическим особенностям ЭВ в группе пациентов, подвергающимся ТГСК. Даны рекомендации по реализации нутриционной терапии в онкогематологичесом центре, а также по экстренной терапии тиаминовой недостаточности.Заключение. В структуре онкогематологических центров, особенно специализирующихся на выполнении ТГСК, оптимальным шагом является создание междисциплинарной службы – лабораторной, гематологической, неврологической, нутрициологической, – ориентированной на нюансы специфических осложнений при противоопухолевом лечении.

Introduction. Hematopoietic stem cell transplantation (HSCT) is a complex method characterized by high-dose chemotherapy exposure, a long period of pancytopenia and the use of immunosuppressants, which can cause undesirable complications, including those involving the nervous system. The most common complications with damage to the nervous system in oncohematology are toxic reactions, infectious, cerebrovascular diseases, and dysmetabolic conditions. Among deficiency states, as a result of thiamine deficiency against the background of impaired appetite and gastrointestinal toxicity syndrome, the development of Wernicke encephalopathy (WE) can be expected.The objective was to detail risk factors for WE in oncohematology and to increase alertness among physicians of various specialties regarding the likelihood of developing this complication during cytostatic, immune therapy and HSCT.Methods and materials. In the framework of the retro- and prospective study, the transplantation activity of the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation from 2018 to 2024 was analyzed. During the study period, 2081 HSCT were performed, among which 5 cases of WE were identified.Results. The risk factors for WE in the study group of patients are presented. Data on the differential diagnosis of WE with other diseases characteristic of the post-transplant period of allo-HSCT are collected. Literature data on the detection rate, clinical, neuroimaging, morphological features of WE in the group of patients undergoing HSCT were analyzed. Recommendations were given for the implementation of nutritional therapy in the oncohematology center, as well as for emergency therapy of thiamine deficiency.Conclusion. In the structure of oncohematological centers, especially those specializing in the implementation of HSCT, the optimal step is the creation of an interdisciplinary service – laboratory, hematological, neurological, nutritional – focused on the nuances of specific complications during antitumor treatment.

энцефалопатия Верникетиаминовая недостаточностьтиаминвитамин В1аллогенная трансплантация костного мозгаосложнения трансплантациидефицитные состоянияWernicke encephalopathythiamine deficiencythiaminevitamin B1allogeneic bone marrow transplantationtransplant complicationsdeficiency statesReferencesNishiguchi T., Mochizuki K., Shakudo M. et al. CNS complications of hematopoietic stem cell transplantation // AJR Am J Roentgenol. – 2009. – Vol. 192, № 4. – P. 1003–11. http://doi.org/10.2214/AJR.08.1787. PMID: 19304707.Nishiguchi T., Mochizuki K., Shakudo M. et al. CNS complications of hematopoietic stem cell transplantation // AJR Am J Roentgenol. 2009;192(4):1003–11. http://doi.org/10.2214/AJR.08.1787. PMID: 19304707.Dhar R. Neurologic Complications of Transplantation // Neurocrit Care. – 2018. – Vol. 28, № 1. – P. 4–11. http://doi.org/10.1007/s12028-017-0387-6.Dhar R. Neurologic Complications of Transplantation // Neurocrit Care. 2018;28(1):4–11. http://doi.org/10.1007/s12028-017-0387-6.Delios A. M., Rosenblum M., Jakubowski A. A. et al. Central and peripheral nervous system immune mediated demyelinating disease after allogeneic hemopoietic stem cell transplantation for hematologic disease // J Neurooncol. – 2012. – Vol. 110, № 2. – P. 251–6. http://doi.org/10.1007/s11060-012-0962-9.Delios A. M., Rosenblum M., Jakubowski A. A. et al. Central and peripheral nervous system immune mediated demyelinating disease after allogeneic hemopoietic stem cell transplantation for hematologic disease // J Neurooncol. 2012;110(2):251–6. http://doi.org/10.1007/s11060-012-0962-9.Syed F. I., Couriel D. R., Frame D. et al. Central Nervous System Complications of Hematopoietic Stem Cell Transplant // Hematol Oncol Clin North Am. – 2016. – Vol. 30, № 4. – P. 887–98. http://doi.org/10.1016/j.hoc.2016.03.009.Syed F. I., Couriel D. R., Frame D. et al. Central Nervous System Complications of Hematopoietic Stem Cell Transplant // Hematol Oncol Clin North Am. 2016;30(4):887–98. http://doi.org/10.1016/j.hoc.2016.03.009.Полушин А. Ю., Скиба Я. Б., Бакин Е. А. и др. Цереброваскулярные осложнения трансплантации гемопоэтических стволовых клеток у пациентов с онкогематологическими заболеваниями // Анналы клинической и экспериментальной неврологии. – 2023. – Т. 17, № 1. – P. 27–35. http://doi.org/10.54101/ACEN.2023.1.4.Polushin A. Yu., Skiba I. B., Bakin E. A. et al. Cerebrovascular complications of hematopoetic stem cell transplantation in patients with hematologic malignancies // Annals of Clinical and Experimental Neurology. 2023;17(1): 27–35. (In Russ.). http://doi.org/10.54101/ACEN.2023.1.4.Graus F., Saiz A., Sierra J. et al. Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study // Neurology. – 1996. – Vol. 46, № 4. – P. 1004–9. http://doi.org/10.1212/wnl.46.4.1004.Graus F., Saiz A., Sierra J. et al. Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study // Neurology. 1996;46(4):1004–9. http://doi.org/10.1212/wnl.46.4.1004.Chen C. Y., Tai C. H., Cheng A. et al. Intracranial hemorrhage in adult patients with hematological malignancies // BMC Med. – 2012. – Vol. 10. – P. 97. http://doi.org/10.1186/1741-7015-10-97.Chen C. Y., Tai C. H., Cheng A. et al. Intracranial hemorrhage in adult patients with hematological malignancies // BMC Med. 2012;10:97. http://doi.org/10.1186/1741-7015-10-97.Lin T. A., Gau J. P., Liu Y. C. et al. Cerebrovascular disease after allogeneic hematopoietic stem cell transplantation: incidence, risk, and clinical outcome // Int J Hematol. – 2019. – Vol. 109, № 5. – P. 584–592. http://doi.org/10.1007/s12185-019-02624-y.Lin T. A., Gau J. P., Liu Y. C. et al. Cerebrovascular disease after allogeneic hematopoietic stem cell transplantation: incidence, risk, and clinical outcome // Int J Hematol.2019;109(5):584–592. http://doi.org/10.1007/s12185-019-02624-y.Chow E. J., Baker K. S., Lee S. J. et al. Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation // J Clin Oncol. – 2014. – Vol. 32, № 3. – P. 191–8. http://doi.org/10.1200/JCO.2013.52.6582.Chow E. J., Baker K. S., Lee S. J. et al. Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation // J Clin Oncol. 2014;32(3):191–8. http://doi.org/10.1200/JCO.2013.52.6582.Полушин А. Ю., Скиба Я. Б., Бакин Е. А. и др. Инсульт перед трансплантацией гемопоэтических стволовых клеток — возможный фактор риска неблагоприятного исхода терапии пациентов с онкогематологическими заболеваниями // Анналы клинической и экспериментальной неврологии. – 2022. – Т. 16, № 2. – C. 36–43. http://doi.org/10.54101/ACEN.2022.2.4.Polushin A. Yu., Skiba I. B., Bakin E. A. et al. Stroke before a haematopoietic stem cell transplantation is a potential risk factor for poor response to therapy in patients with blood cancer // Annals of Clinical and Experimental Neurology. 2022;16(2):36–43. (In Russ.). http://doi.org/10.54101/ACEN.2022.2.4.Афанасьев Б. В., Зубаровская Л. С., Алянский А. Л. и др. Выбор донора при аллогенной трансплантации гемопоэтических стволовых клеток // Российский журнал детской гематологии и онкологии (РЖДГиО). – 2016. – Т. 3, № 3. – С. 30–36. https://doi.org/10.17650/2311-1267-2016-3-3-30-36.Afanasiev B. V., Zubarovskaya L. S., Alyanskiy A. L. et al. Selection of donor of allogeneic hematopoietic stem cell transplantation // Russian Journal of Pediatric Hematology and Oncology. 2016;3(3):30–36. (In Russ.). https://doi.org/10.17650/2311-1267-2016-3-3-30-36.Labrador J., Lopez-Anglada L., Perez-Lopez E. et al. Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients // Haematologica. – 2013. – Vol. 98, № 3. – P. 437–43. http://doi.org/10.3324/haematol.2012.069559.Labrador J., Lopez-Anglada L., Perez-Lopez E. et al. Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients // Haematologica. 2013;98(3):437–43. http://doi.org/10.3324/haematol.2012.069559.Полушин А. Ю., Скиба Я. Б., Владовская М. Д. Спектр неврологической патологии у пациентов со злокачественными гематологическими заболеваниями на входе в трансплантацию костного мозга // Госпитальная медицина: наука и практика. – 2023. – Т. 6, № 6. – C. 47–55. http://doi.org/10.34852/GM3CVKG.2023.48.45.059.Polushin A. Yu., Skiba Ya. B., Vladovskaya M. D. Spectrum of neurological pathology in patients with malignant hematological diseases at the entrance to bone marrow transplantation // Gospitalnaya medicina: nauka i praktika. 2023;6(6):47–55. (In Russ.). http://doi.org/10.34852/GM3CVKG.2023.48.45.059.Скиба Я. Б., Полушин А. Ю., Прокудин М. Ю. и др. Остро возникшие симптоматические эпилептические приступы при проведении трансплантации гемопоэтических стволовых клеток // Эпилепсия и пароксизмальные состояния. – 2021. – Т. 13, № 1. – С. 65–82. https://doi.org/10.17749/2077-8333/epi.par.con.2021.049.Skiba Ya. B., Polushin А. Yu., Prokudin М. Yu. et al. Acute symptomatic seizures during haematopoietic stem cell transplantation // Epilepsia I paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions. 2021;13 (1):65–82. (In Russ.). https://doi.org/10.17749/2077-8333/epi.par.con.2021.049.Бардаков С. Н., Полушин А. Ю., Царгуш В. А. и др. Анти-MuSK-миастения как осложнение аллогенной трансплантации. Российский неврологический журнал. – 2022. – Т. 27, № 4. – С. 44–54. https://doi.org/10.30629/2658-7947-2022-27-4-44-54.Bardakov S. N., Polushin A. Yu., Tsargush V. A. et al. Anti-MuSK myasthenia after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia // Russian neurological journal. 2022;27(4):44–54. (In Russ.). https://doi.org/10.30629/2658-7947-2022-27-4-44-54.Denier C., Bourhis J. H., Lacroix C. et al. Spectrum and prognosis of neurologic complications after hematopoietic transplantation // Neurology. – 2006. – Vol. 67, № 11. – P. 1990– 7. http://doi.org/10.1212/01.wnl.0000247038.43228.17.Denier C., Bourhis J. H., Lacroix C. et al. Spectrum and prognosis of neurologic complications after hematopoietic transplantation // Neurology. 2006;67(11):1990–7. http://doi.org/10.1212/01.wnl.0000247038.43228.17.Rosenfeld M. R., Pruitt A. Neurologic complications of bone marrow, stem cell, and organ transplantation in patients with cancer // SeminOncol. – 2006. – Vol. 33, № 3. – P. 352–61. http://doi.org/10.1053/j.seminoncol.2006.03.003.Rosenfeld M. R., Pruitt A. Neurologic complications of bone marrow, stem cell, and organ transplantation in patients with cancer // SeminOncol. 2006;33(3):352–61. http://doi.org/10.1053/j.seminoncol.2006.03.003.Jagannathan J. P., Ramaiya N., Gill R. R. et al. Imaging of complications of hematopoietic stem cell transplantation // RadiolClin North Am. – 2008. – Vol. 46, № 2. – P. 397–417, x. http://doi.org/10.1016/j.rcl.2008.04.004.Jagannathan J. P., Ramaiya N., Gill R. R. et al. Imaging of complications of hematopoietic stem cell transplantation // RadiolClin North Am. 2008;46(2):397–417, x. http://doi.org/10.1016/j.rcl.2008.04.004.Quant E. C., Wen P. Y. Response assessment in neuro-oncology // CurrOncol ReP. – 2011. – Vol. 13, № 1. – P. 50–6. http://doi.org/10.1007/s11912-010-0143-y.Quant E. C., Wen P. Y. Response assessment in neuro-oncology // CurrOncol ReP. 2011;13(1):50–6. http://doi.org/10.1007/s11912-010-0143-y.Weber C., Schaper J., Tibussek D. et al. Diagnostic and therapeutic implications of neurological complications following paediatrichaematopoietic stem cell transplantation // Bone Marrow Transplant. – 2008. – Vol. 41, № 3. – P. 253–259. http://doi.org/10.1038/sj.bmt.1705905.Weber C., Schaper J., Tibussek D. et al. Diagnostic and therapeutic implications of neurological complications following paediatrichaematopoietic stem cell transplantation // Bone Marrow Transplant. 2008;41(3):253–259. http://doi.org/10.1038/sj.bmt.1705905.Pruitt A., Graus F., Rosenfeld M. Neurological Complications of Transplantation. – P. Part I. – P. Hematopoietic Cell Transplantation // Neurohospitalist. – 2013. – Vol. 3, № 1. – P. 24–38. http://doi.org/10.1177/1941874412455338.Pruitt A., Graus F., Rosenfeld M. Neurological Complications of Transplantation: Part I: Hematopoietic Cell Transplantation // Neurohospitalist. 2013;3(1):24–38. http://doi.org/10.1177/1941874412455338.Dowling M. R., Li S., Dey B. R. et al. Neurologic complications after allogeneic hematopoietic stem cell transplantation: risk factors and impact // Bone Marrow Transplant. – 2018. – Vol. 53, № 2. – P. 199–206. http://doi.org/10.1038/bmt.2017.239.Dowling M. R., Li S., Dey B. R. et al. Neurologic complications after allogeneic hematopoietic stem cell transplantation: risk factors and impact // Bone Marrow Transplant. 2018;53(2):199–206. http://doi.org/10.1038/bmt.2017.239.Диагностика и лечение энцефалопатии Вернике. Методические рекомендации №2. ГБУЗ г. Москвы НИИ скорой помощи им. Н. В. Склифосовского. – 2024. – С. 35. URL: https://niioz.ru/upload/iblock/254/25473a16a283e0c960dc5cd76101f7d6.pdf?ysclid=m7h9g5yfnr495765749 (дата обращения: 20.06.2025).Diagnostics and treatment of Wernicke’s encephalopathy. Guidelines No. 2. State Budgetary Healthcare Institution of Moscow, N. V. Sklifosovsky Research Institute of Emergency Care, 2024. 35 P. URL: https://niioz.ru/upload/iblock/254/25473a16a-283e0c960dc5cd76101f7d6.pdf?ysclid=m7h9g5yfnr495765749 (accessed: 20.06.2025). (In Russ.).Ломиворотов В. В., Дерягин М. Н., Абубакиров М. Н. и др. Дефицит тиамина и его коррекция при критических состояниях // Вестник анестезиологии и реаниматологии. – 2017. – Т. 14, № 5. – С. 73-81. https://10.21292/2078-5658-2017-14-5-73-81.Lomivorotov V. V., Deryagin M. N., Abubakirov M. N. et al. Thiamine deficiency and its management in critical states // Messenger of anesthesiology and resuscitation. 2017;14(5):73–81. (In Russ.). http://doi.org/10.21292/2078-5658-2017-14-5-73-81.Bleggi-Torres L., de Medeiros B., Ogasawara V. et al. Iatrogenic Wernicke’s encephalopathy in allogeneic bone marrow transplantation: a study of eight cases // Bone Marrow Transplant. – 1997. – Vol. – 20. – P. 391–395. http://doi.org/10.1038/sj.bmt.1700892.Bleggi-Torres L., de Medeiros B., Ogasawara V. et al. Iatrogenic Wernicke’s encephalopathy in allogeneic bone marrow transplantation: a study of eight cases // Bone Marrow Transplant. 1997;20:391–395. http://doi.org/10.1038/sj.bmt.1700892.Bleggi-Torres L. F., de Medeiros B. C., Werner B. et al. Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases // Bone Marrow Transplant. – 2000. – Vol. 25, № 3. – P. 301–7. http://doi.org/10.1038/sj.bmt.1702140.Bleggi-Torres L. F., de Medeiros B. C., Werner B. et al. Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases // Bone Marrow Transplant. 2000;25(3):301–7. http://doi.org/10.1038/sj.bmt.1702140.Harper C. The incidence of Wernicke’s encephalopathy in Australia – a neuropathological study of 131 cases // J Neurol Neurosurg Psychiatry. – 1983. – Vol. 46, № 7. – P. 593–8. http://doi.org/10.1136/jnnp.46.7.593.Harper C. The incidence of Wernicke’s encephalopathy in Australia--a neuropathological study of 131 cases // J Neurol Neurosurg Psychiatry. 1983;46(7):593–8. http://doi.org/10.1136/jnnp.46.7.593.Неймарк А. Е., Лапшина С. Е., Молоткова М. А. Энцефалопатия Вернике после продольной резекции желудка // Ожирение и метаболизм. – 2023. – Т. 20, № 2. – С. 158– 62. https://doi.org/10.14341/omet12965.Neimark A. E., Lapshina S. E., Molotkova M. A. Wernicke’s encephalopathy after longitudinal gastrectomy // Obesity and Metabolism. 2023;20(2):158– 62. (In Russ.). https://doi.org/10.14341/omet12965.Oudman E., Wijnia J. W., van Dam M. et al. Preventing Wernicke encephalopathy after bariatric surgery // Obes Surg. – 2018. – Vol. 28, № 7. – P. 2060–8. https://doi.org/10.1007/s11695-018-3262-4.Oudman E., Wijnia J. W., van Dam M. et al. Preventing Wernicke encephalopathy after bariatric surgery // Obes Surg. 2018;28(7):2060–8. https:// doi.org/10.1007/s11695-018-3262-4.Рамазанов Г. Р., Ковалёва Э. А., Степанов В. Н. и др. Клинические случаи энцефалопатии Вернике. Неотложная медицинская помощь. – 2020. – Т. 9, № 2. – С. 292– 7. https://doi.org/10.23934/2223-9022-2020-9-2-292-297.Ramazanov G. R., Kovaleva E. A., Stepanov V. N. et al. Clinical Cases of Wernicke Encephalopathy // Russian Sklifosovsky Journal “Emergency Medical Care”. 2020;9(2):292– 297. (In Russ.). https://doi.org/10.23934/2223-9022-2020-9-2-292-297.Емельянова Э. А., Асекритова А. С., Семенова Т. И., Николаева К. М. Энцефалопатия Вернике: наблюдения из практики // Современные проблемы науки и образования. – 2019. – Т. 6. – С. 208–9. http://doi.org/10.25005/2074-0581-2024-26-3-508-518.Akhmadeeva L. R., Galimov O. V., Baykov D. E. et al. Wernicke encephalopathy following bariatric surgery: Case report // Avicenna Bulletin. 2024;26(3):508–18. (In Russ.). https://doi.org/10.25005/2074-0581-2024-26-3-508-518.Сердюк А. В., Ковражкина Е. А., Абрамова Н. Г. Случай энцефалопатии Вернике неалкогольного генеза: клинический обзор // Consilium Medicum. – 2019. – Т. 21, № 9. – С. 44–7. https://doi.org/10.26442/20751753.2019.9.190458.Serdiuk A. V., Kovrazhkina E. A., Abramova E. A. Case of Wernike’s encephalopathy non-alcoholic genesis // Consilium Medicum. 2019;21(9):44–7. (In Russ.). https://doi.org/10.26442/20751753.2019.9.190458.Kudru C. U., Nagiri S. K., Rao S. Wernicke’s encephalopathy in a patient with gastric carcinoma: A diagnosis not to miss // BMJ Case ReP. – 2014. – Vol. – 2014. – P. bcr2013203511. https://doi.org/10.1136/bcr-2013-203511.Kudru C. U., Nagiri S. K., Rao S. Wernicke’s encephalopathy in a patient with gastric carcinoma: A diagnosis not to miss // BMJ Case ReP. 2014;2014:bcr2013203511. https://doi.org/10.1136/bcr-2013-203511.Zhang Y., Tan X. M., Zhou H. B. Wernicke encephalopathy after allogeneic hematopoietic stem cell transplantation: a case report // Zhonghua Xue Ye Xue Za Zhi. – 2022. – Vol. 43, № 1. – P. 81. Chinese. http://doi.org/10.3760/cma.j.issn.0253-2727.2022.01.019.Zhang Y., Tan X. M., Zhou H. B. Wernicke encephalopathy after allogeneic hematopoietic stem cell transplantation: a case report // Zhonghua Xue Ye Xue Za Zhi. 2022;43(1):81. Chinese. http://doi.org/10.3760/cma.j.issn.0253-2727.2022. 01.019.Xiao Q. Q., Yu X. L., Song X. C. et al. Wernicke’s encephalopathy after haploid hematopoietic stem cell transplantation: 3 cases report and literature review // ZhonghuaXue Ye XueZaZhi. – 2024. – Vol. 45, № 8. – P. 781–784. Chinese. http://doi.org/10.3760/cma.j.cn121090-20231214-00309.Xiao Q. Q., Yu X. L., Song X. C. et al. Wernicke’s encephalopathy after haploid hematopoietic stem cell transplantation: 3 cases report and literature review // ZhonghuaXue Ye XueZaZhi. 2024;45(8):781–784. Chinese. http://doi.org/10.3760/cma.j.cn121090-20231214-00309.Choi Y. J., Park S. J., Kim J. S. et al. Wernicke’s encephalopathy following allogeneic hematopoietic stem cell transplantation // Korean J Hematol. – 2010. – Vol. 45, № 4. – P. 279–81. http://doi.org/10.5045/kjh.2010.45.4.279.Choi Y. J., Park S. J., Kim J. S. et al. Wernicke’s encephalopathy following allogeneic hematopoietic stem cell transplantation // Korean J Hematol. 2010;45(4):279–81. http://doi.org/10.5045/kjh.2010.45.4.279.Sechi G., Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management // Lancet Neurol. – 2007. – Vol. 6, № 5. – P. 442–55. http://doi.org/10.1016/S1474-4422(07)70104-7.Sechi G., Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management // Lancet Neurol. 2007;6(5):442–55. http://doi.org/10.1016/S1474-4422(07)70104-7.Donnino M. W., Vega J., Miller J., Walsh M. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know // Ann Emerg Med. – 2007. – Vol. 50, № 6. – P. 715–21. http://doi.org/10.1016/j.annemergmed.2007.02.007.Donnino M. W., Vega J., Miller J., Walsh M. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know// Ann Emerg Med. 2007;50(6):715– 21. http://doi.org/10.1016/j.annemergmed.2007.02.007.Arends J., Bodoky G., Bozzetti F. et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology // Clin Nutr. – 2006. – Vol. 25, № 2. – P. 245–59. http://doi.org/10.1016/j.clnu.2006.01.020.Arends J., Bodoky G., Bozzetti F. et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology // Clin Nutr. 2006;25(2):245–59. http://doi.org/10.1016/j.clnu.2006.01.020.Bathla G., Hegde A. N. MRI and CT appearances in metabolic encephalopathies due to systemic diseases in adults // ClinRadiol. – 2013. – Vol. 68, № 6. – P. 545–54. http://doi.org/10.1016/j.crad.2012.05.021.Bathla G., Hegde A. N. MRI and CT appearances in metabolic encephalopathies due to systemic diseases in adults // ClinRadiol. 2013;68(6):545–54. http://doi.org/10.1016/j.crad.2012.05.021.Полушин А. Ю., Краснов В. С., Бардаков С. Н. и др. Миелопатия, ассоциированная с острым лейкозом. Мультидисциплинарный взгляд на проблему // Российский неврологический журнал. – 2020. – Т. 25, № 6. – С. 19–28. https://doi.org/10.30629/2658-7947-2020-25-6-19-28.Polushin A. Yu., Krasnov V. S., Bardakov S. N. et al. Myelopathy associated with acute leukemia. Multidisciplinary view on the problem // Russian neurological journal. 2020;25(6):19–28. (In Russ.). https://doi.org/10.30629/2658-7947-2020-25-6-19-28.Salmon D. P. The Wernicke-korsakoff-syndrome and related neurologic disorders due to alcoholism and malnutrition (2nd ed.) // J Stud Alcohol Drugs. – 1991. – Vol. 52. – P. 89–90.Salmon D. P. The Wernicke-korsakoff-syndrome and related neurologic disorders due to alcoholism and malnutrition (2nd ed.) // J Stud Alcohol Drugs. 1991;52:89–90.Choi Y. J., Park S. J., Kim J. S. et al. Wernicke’s encephalopathy following allogeneic hematopoietic stem cell transplantation // Korean J Hematol. – 2010. – Vol. 45, № 4. – P. 279–81. http://doi.org/10.5045/kjh.2010.45.4.279.Choi Y. J., Park S. J., Kim J. S. et al. Wernicke’s encephalopathy following allogeneic hematopoietic stem cell transplantation // Korean J Hematol. 2010;45(4):279–81. http://doi.org/10.5045/kjh.2010.45.4.279.Majolino I., Caponetto A., Scimé R. et al. Wernicke-like encephalopathy after autologous bone marrow transplantation // Haematologica. 1990. – Vol. 75, № 3. – P. 282–4. PMID: 2227627.Majolino I., Caponetto A., Scimé R. et al. Wernicke-like encephalopathy after autologous bone marrow transplantation // Haematologica. 1990;75(3):282–4. PMID: 2227627.Halfdanarson T. R., Litzow M. R., Murray J. A. Hematologic manifestations of celiac disease // Blood. – 2007. – Vol. 109, № 2. – P. 412–21. http://doi.org/10.1182/blood-2006-07-031104.Halfdanarson T. R., Litzow M. R., Murray J. A. Hematologic manifestations of celiac disease // Blood. 2007;109(2):412–21. http://doi.org/10.1182/blood-2006-07-031104.Thornalley P. J., Babaei-Jadidi R., Al Ali H. et al. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease // Diabetologia. – 2007. – Vol. 50, № 10. – P. 2164–70. http://doi.org/10.1007/s00125-007-0771-4.Thornalley P. J., Babaei-Jadidi R., Al Ali H. et al. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease // Diabetologia. 2007;50(10):2164–70. http://doi.org/10.1007/s00125-007-0771-4.Hanberry B. S., Berger R., Zastre J. A. High-dose vitamin B1 reduces proliferation in cancer cell lines analogous to dichloroacetate // Cancer Chemother Pharmacol. – 2014. – Vol. 73, № 3. – P. 585–94. http://doi.org/10.1007/s00280-014-2386-z.Hanberry B. S., Berger R., Zastre J. A. High-dose vitamin B1 reduces proliferation in cancer cell lines analogous to dichloroacetate // Cancer Chemother Pharmacol. 2014;73(3):585–94. http://doi.org/10.1007/s00280-014-2386-z.Page G. L., Laight D., Cummings M. H. Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease // Int J Clin Pract. – 2011. – Vol. 65, № 6. – P. 684–90. http://doi.org/10.1111/j.1742-1241.2011.02680.x.Page G. L., Laight D., Cummings M. H. Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease // Int J Clin Pract. 2011;65(6):684–90. http://doi.org/10.1111/j.1742-1241.2011.02680.x.Pizzo P. A., Purvis D. S., Waters C. Microbiological evaluation of food items. For patients undergoing gastrointestinal decontamination and protected isolation // J Am Diet Assoc. 1982. – Vol. 81, № 3. – P. 272–9. PMID: 7108083Pizzo P. A., Purvis D. S., Waters C. Microbiological evaluation of food items. For patients undergoing gastrointestinal decontamination and protected isolation // J Am Diet Assoc. 1982;81(3):272–9. PMID: 7108083Trifilio S., Helenowski I., Giel M. et al. Questioningtheroleof a neutropenicdietfollowinghematopoeticstemcelltransplantation // Biol Blood Marrow Transplant. – 2012. – Vol. 18, № 9. – P. 1385–90. http://doi.org/10.1016/j.bbmt.2012.02.015.Trifilio S., Helenowski I., Giel M. et al. Questioningtheroleof a neutropenicdietfollowinghematopoeticstemcelltransplantation // Biol Blood Marrow Transplant. 2012;18(9):1385– 90. http://doi.org/10.1016/j.bbmt.2012.02.015.Ifversen M., Meisel R., Sedlacek P. et al. Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) // FrontPediatr. – 2021. – Vol. 9. – P. 705179. http://doi.org/10.3389/fped.2021.705179.Ifversen M., Meisel R., Sedlacek P. et al. Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) // FrontPediatr. 2021;9:705179. http://doi.org/10.3389/fped.2021.705179.Page G. L., Laight D., Cummings M. H. Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease // Int J Clin Pract. – 2011. – Vol. 65, № 6. – P. 684–90. http://doi.org/10.1111/j.1742-1241.2011.02680.x.Page G. L., Laight D., Cummings M. H. Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease // Int J Clin Pract. 2011;65(6):684–90. http://doi.org/10.1111/j.1742-1241.2011.02680.x.Williams B., Mancia G., Spiering W. et al. 2018 ESC/ ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension // J Hypertens. – 2018. – Vol. 36, № 10. – P. 1953–2041. http://doi.org/10.1097/HJH.0000000000001940.Williams B., Mancia G., Spiering W. et al. 2018 ESC/ ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension // J Hypertens. 2018;36(10):1953–2041. http://doi.org/10.1097/HJH.0000000000001940.Zuccoli G., Gallucci M., Capellades J. et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients // AJNR Am J Neuroradiol. – 2007. – Vol. 28, № 7. – P. 1328–31. http://doi.org/10.3174/ajnr.A0544.Zuccoli G., Gallucci M., Capellades J. et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients // AJNR Am J Neuroradiol. 2007;28(7):1328–31. http://doi.org/10.3174/ajnr.A0544.Fei G. Q., Zhong C., Jin L. et al. Clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy // AJNR Am J Neuroradiol. – 2008. – Vol. 29, № 1. – P. 164–9. http://doi.org/10.3174/ajnr.A0827.Fei G. Q., Zhong C., Jin L. et al. Clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy // AJNR Am J Neuroradiol. 2008;29(1):164–9. http://doi.org/10.3174/ajnr.A0827.Rugilo C. A., Uribe Roca M. C., Zurru M. C. et al. Proton MR spectroscopy in Wernicke encephalopathy // AJNR Am J Neuroradiol. – 2003. – Vol. 24, № 5. – P. 952–5. PMID: 12748100. – Vol. PMCID. – P. PMC7975767.Rugilo C. A., Uribe Roca M. C., Zurru M. C. et al. Proton MR spectroscopy in Wernicke encephalopathy // AJNR Am J Neuroradiol. 2003;24(5):952–5. PMID: 12748100; PMCID: PMC7975767.Zuccoli G., Santa Cruz D., Bertolini M. et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics // AJNR Am J Neuroradiol. – 2009. – Vol. 30, № 1. – P. 171–6. http://doi.org/10.3174/ajnr.A1280.Zuccoli G., Santa Cruz D., Bertolini M. et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics // AJNR Am J Neuroradiol. 2009;30(1):171–6. http://doi.org/10.3174/ajnr.A1280.Case-based brain imaging / eds by John A. Tsiouris, Pina C. Sanelli, Joseph P. Comunale. – 2nd ed. 688 P. ISBN 978-1-60406-953-2.Case-based brain imaging / eds by A. John Tsiouris, Pina C. Sanelli, Joseph P. Comunale. — 2nd ed. 688 P. ISBN 978-1-60406-953-2.Peixoto M. A. L., Santos E. C., Pittella J. E. H. Coma and death in Bone Marrow Transplantation unrecognized Wernicke’s encephalopathy // Arq Neuropsiquiat. – 1992. – Vol. 50. – P. 329–333.Peixoto M. A. L., Santos E. C., Pittella J. E. H. Coma and death in Bone Marrow Transplantation unrecognized Wernicke’s encephalopathy // Arq Neuropsiquiat 1992;50:329–333.Zhang S. X., Weilersbacher G. S., Henderson S. W. et al. Excitotoxic cytopathology, progression, and reversibility of thiamine deficiency-induced diencephalic lesions // J Neuropathol Exp Neurol. 1995. – Vol. 54, № 2. – P. 255–67. http://doi.org/10.1097/00005072-199503000-00012.Zhang S. X., Weilersbacher G. S., Henderson S. W. et al. Excitotoxic cytopathology, progression, and reversibility of thiamine deficiency-induced diencephalic lesions // J Neuropathol Exp Neurol. 1995;54(2):255–67. http://doi.org/10.1097/00005072-199503000-00012.Patel S., Topiwala K., Hudson L. Wernicke’s Encephalopathy // Cureus. – 2018. – Vol. 10, № 8. – P. e3187. http://doi.org/10.7759/cureus.3187.Patel S., Topiwala K., Hudson L. Wernicke’s Encephalopathy // Cureus. 2018;10(8):e3187. http://doi.org/10.7759/cureus.3187.Galvin R., Bråthen G., Ivashynka A. et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy // Eur J Neurol. – 2010. – Vol. 17, № 12. – P. 1408–18. http://doi.org/10.1111/j.1468-1331.2010.03153.x.Galvin R., Bråthen G., Ivashynka A. et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy // Eur J Neurol. 2010;17(12):1408–18. http://doi.org/10.1111/j.1468-1331.2010.03153.x.Thomson A. D., Cook C. C., Touquet R. et al. The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the accident and Emergency Department // Alcohol Alcohol. – 2002. – Vol. 37, № 6. – P. 513–21. http://doi.org/10.1093/alcalc/37.6.513.Thomson A. D., Cook C. C., Touquet R. et al. The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the accident and Emergency Department // Alcohol Alcohol. 2002;37(6):513– 21. http://doi.org/10.1093/alcalc/37.6.513.Paparrigopoulos T., Tzavellas E., Karaiskos D. et al. Complete recovery from undertreated Wernicke-Korsakoff syndrome following aggressive thiamine treatment // In Vivo. – 2010. – Vol. 24, № 2. – P. 231–3. PMID: 20364001.Paparrigopoulos T., Tzavellas E., Karaiskos D. et al. Complete recovery from undertreated Wernicke-Korsakoff syndrome following aggressive thiamine treatment // In Vivo. 2010;24(2):231–3. PMID: 20364001.Thomson A. D., Marshall E. J., Guerrini I. Biomarkers for detecting thiamine deficiency--improving confidence and taking a comprehensive history are also important // Alcohol Alcohol. – 2010. – Vol. 45, № 2. – P. 213. http://doi.org/10.1093/alcalc/agq004.Thomson A. D., Marshall E. J., Guerrini I. Biomarkers for detecting thiamine deficiency--improving confidence and taking a comprehensive history are also important // Alcohol Alcohol. 2010;45(2):213. http://doi.org/10.1093/alcalc/agq004.Solmaz S., Gereklioğlu Ç., Tan M. et al. A Rare Complication Developing After Hematopoietic Stem Cell Transplantation: Wernicke’s Encephalopathy // Turk J Haematol. – 2015. – Vol. 32, № 4. – P. 367–70. http://doi.org/10.4274/tjh.2014.0412.Solmaz S., Gereklioğlu Ç., Tan M. et al. A Rare Complication Developing After Hematopoietic Stem Cell Transplantation: Wernicke’s Encephalopathy // Turk J Haematol. 2015;32(4):367–70. http://doi.org/10.4274/tjh.2014.0412.Hendler S. S, Rorvik D. M. PDR for nutritional supplements. 2nd edition. Thompson Reuters. 2008, 788 P.Hendler S. S, Rorvik D. M. PDR for nutritional supplements. 2ndedition. Thompson Reuters. 2008, 788 P.Методические рекомендации MP 2.3.1.0253-21 от 22.07.2021 «Нормы физиологических потребностей в энергии и пищевых веществах для различных групп населения Российской Федерации. https://782329.selcdn.ru/leonardo/uploadsForSiteId/203558/content/3dbf9bd9-7cc6-4889-b183-da40b5c0a155.pdf (дата обращения: 20.06.2025).Methodological recommendations MP 2.3.1.0253- 21 of 07/22/2021 “Norms of physiological needs for energy and nutrients for various population groups of the Russian Federation”. URL: https://782329.selcdn.ru/leonardo/uploadsForSiteId/203558/content/3dbf9bd9-7cc6-4889-b183-da40b5c0a155.pdf (accessed: 20.06.2025). (In Russ.).Berger M. M., Shenkin A., Dizdar O. S. et al. ESPEN practical short micronutrient guideline // Clin Nutr. – 2024. – Vol. 43, № 3. – P. 825–857. http://doi.org/10.1016/j.clnu.2024.01.030.Berger M. M., Shenkin A., Dizdar O. S. et al. ESPEN practical short micronutrient guideline // Clin Nutr. 2024;43(3):825– 857. http://doi.org/10.1016/j.clnu.2024.01.030.

The authors declare that there are no conflicts of interest present.