76
|
Kleinert-Altamirano API, Juárez-Jiménez H. [Wernicke's encephalopathy and Caine criteria. Report of six cases]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2014; 52:104-107. [PMID: 24625493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Wernicke's encephalopathy is an acute and reversible neurologic disorder due to deficiency of thiamin. Chronic alcoholism was the main cause in the past; currently, there are many other situations which favour this condition: prolonged intravenous feeding, hyperemesis gravidarum, anorexia nervosa, regional enteritis, malabsorption syndrome, hemodialysis, peritoneal dialysis, and abdominal surgery. CLINICAL CASE We report six patients, three male and three female, who had in common total parenteral nutrition over two months, secondary to abdominal surgery complications and restriction to enteral nutrition. Clinical manifestations were drowsiness, psychomotor hyperactivity, ophthalmoplegia with bilateral abduction impairment, horizontal nystagmus; three patients with ataxia and appendicular dysmetria. Magnetic resonance imaging showed abnormal T2 hyperintensity of the superior colliculus, periaqueductal gray matter, mammillary bodies and dorsomedial nucleus of the thalamus, as well as abnormal T1 hyperintensity in both lenticular nucleus from manganese deposits due to total parenteral nutrition. CONCLUSIONS The classical triad is global confusional state, ocular abnormalities and ataxia. However, using the Caine criteria, the diagnosis could be faster in susceptible patients without previous alcoholism.
Collapse
|
77
|
Hiraki A, Kikuchi M. [Wernicke's encephalopathy due to excessive intake of isotonic drink; report of 2 cases]. NO TO HATTATSU = BRAIN AND DEVELOPMENT 2014; 46:34-38. [PMID: 24620429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Wernicke's encephalopathy (WE) is an acute neurological disease resulting from thiamine (vitamin B1) deficiency. WE is often caused by an unbalanced diet or excessively strict diet therapy in pediatric cases. We experienced 2 cases of WE due to excessive intake of isotonic drink. Patient 1 was a 15-month-old boy. After frequent vomiting, he presented with mental status changes, ocular abnormalities, and truncal ataxia (the classic triad). Patient 2 was a 7-month-old boy. He was hospitalized because of status epilepticus. In both cases, the clinical symptoms improved immediately after the administration of vitamin B1. However, mental retardation was observed as a neurological sequel in patient 2. Because many patients with WE present with vomiting at an early stage, we should take care not to confuse WE with gastroenterocolitis. In addition, it should be noted that some patients with WE present with seizure. Because these 2 cases resulted from an unbalanced diet, it is important to evaluate the patients' eating and drinking habits and advise their parents on proper nutrition. Since many people believe that isotonic drinks are very beneficial and consume them frequently, we should promote awareness that they can be harmful when consumed in excess.
Collapse
|
78
|
Justin C, Annamalai AK, Pricilla G, Muralidharan K, Srinivasan KG, Gurnell M. More than just morning sickness. QJM 2013; 106:1123-5. [PMID: 23842485 DOI: 10.1093/qjmed/hct153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
79
|
Ma L, Lin Z, Chen D. Wernicke encephalopathy following nutritional deficiency in a patient with multiple trauma. Anaesth Intensive Care 2013; 41:816-817. [PMID: 24180735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
80
|
Freund U. Wernicke encephalopathy after surgery for morbid obesity. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2013; 15:526. [PMID: 24340850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
81
|
Muggia M, Iman-Dayan K. Wernicke encephalopathy after surgery for morbid obesity. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2013; 15:526. [PMID: 24340851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
82
|
Nilsson M, Sonne C. [Diagnostics and treatment of Wernicke-Korsakoff syndrome patients with an alcohol abuse]. Ugeskr Laeger 2013; 175:942-944. [PMID: 23582065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Wernicke-Korsakoff syndrome is a condition with high morbidity and mortality and occurs as a consequence of thiamine deficiency. Clinical symptoms are often ambiguous and post-mortem examinations show that the syndrome is underdiagnosed and probably undertreated. There is sparse clinical evidence concerning optimal dosage and duration of treatment. This article reviews the current literature and concludes that all patients with a history of alcohol abuse should be treated with high dosage IV thiamine for an extended period of time, albeit further research is needed.
Collapse
|
83
|
Abstract
An inadequate supply of thiamine (vitamin B) to the brain can result in Wernicke's encephalopathy, which is an acute neuropsychiatric disorder This article explains the known risk of thiamine deficiency in people who are dependent on or misuse alcohol. The importance of making parenteral vitamin supplements available to patients in a community alcohol service is outlined. A project that has provided intramuscular thiamine supplementation to reduce the likelihood of long-term brain damage is described.
Collapse
|
84
|
Sivolap IP, Damulin IV. [Wernicke encephalopathy and Korsakoff's psychosis: clinical-pathophysiological correlation, diagnostics and treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2013; 113:20-26. [PMID: 23887463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Wernicke's encephalopathy and Korsakoff's psychosis are severe unfavorable forms of alcoholic brain damage with poor prognosis. Thiamine deficiency represents a common cause of both diseases. In many cases, Korsakoff's psychosis develops in the outcome of Wernicke's encephalopathy, which, along with the general etiology, lets talk about a single disease - Wernicke-Korsakoff syndrome, acute (usually reversible) stage of which is Wernicke's encephalopathy and a chronic one (often irreversible) is Korsakoff psychosis. The dramatic paradox of Wernicke's encephalopathy is that in most cases it is difficult to detect, but early diagnosed cases are quite easy to cure. Unrecognized and therefore go untreated Wernicke's encephalopathy is a serious threat to the health and lives of patients, worsens the processes of brain aging and increases the risk of Alzheimer's disease in later life. The basic approach to the treatment of Wernicke-Korsakoff syndrome is long-term parenteral administration of thiamine, often in high doses. As an adjuvant means of therapy memantine is considered.
Collapse
|
85
|
Nakashima Y, Ito K, Nakashima H, Shirakawa A, Abe Y, Ogahara S, Sasatomi Y, Yasunaga T, Ifuku M, Tsugawa J, Tsuboi Y, Saito T. Wernicke's encephalopathy that developed during the introduction period of peritoneal dialysis. Intern Med 2013; 52:2093-7. [PMID: 24042519 DOI: 10.2169/internalmedicine.52.9427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 43-year-old man was admitted with end-stage renal disease caused by IgA nephropathy, and was treated with maintenance peritoneal dialysis. The patient developed general fatigue and appetite loss, and his symptoms were gradually aggravated by depression. After approximately 2 months on dialysis, the patient presented with altered consciousness and ophthalmoplegia. Wernicke's encephalopathy was diagnosed based on the presence of classic symptoms and the findings on magnetic resonance imaging. Thiamine replacement therapy was immediately initiated. The patient recovered from most of his neurological symptoms; however, the sequela of Korsakoff syndrome remained. A marginal thiamine deficiency in combination with predisposing factors must be considered when treating dialysis patients.
Collapse
|
86
|
Jethava A, Dasanu CA. Acute Wernicke encephalopathy and sensorineural hearing loss complicating bariatric surgery. CONNECTICUT MEDICINE 2012; 76:603-605. [PMID: 23243762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Health-care professionals must be aware of the mandatory vitamin supplementation in patients status post bariatric surgery. A recent increase in the number of gastric bypass surgeries in US has been associated with a proportional increase in Wernicke encephalopathy reports. Subtle or atypical neurologic features are not uncommon. Our report is of a female patient with acute Wernicke encephalopathy accompanied by sensorineural hearing loss six weeks after bariatric surgery. The patient had only a partial recovery of her neurologic symptoms eightweeks after vigorous therapy for this condition. Symptomatic thiamine (vitamin B1) and vitamin B12 deficiencies are particularly concerning effects of bariatric procedures, as neurologic and cognitive deficits may be long lasting or even permanent despite aggressive replacement therapy.
Collapse
|
87
|
Sharabi S, Bisharat N. Wernicke encephalopathy after sleeve gastrectomy. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2012; 14:708-709. [PMID: 23240381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
88
|
Raziel A. Thiamine deficiency after bariatric surgery may lead to Wernicke encephalopathy. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2012; 14:692-694. [PMID: 23240377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
89
|
Krokos N, Karakatsanis A, Sarafianos P, Koukou S. Wernicke's encephalopathy complicating acute necrotic pancreatitis. Am Surg 2012; 78:E390-E392. [PMID: 22964173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
90
|
Daaloul W, Jlili L, Ouerdiane N, Masmoudi A, Ben Hamouda S, Bouguerra B, Sfar R. [Fatal complication of hyperemesis gravidarum: Wernicke's encephalopathy]. LA TUNISIE MEDICALE 2012; 90:663. [PMID: 22987369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
91
|
Baer TE, DiVasta A. An unusual complication of rapid weight loss. ADOLESCENT MEDICINE: STATE OF THE ART REVIEWS 2012; 23:215-221. [PMID: 23162923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
92
|
Thomson AD, Guerrini I, Marshall EJ. The evolution and treatment of Korsakoff's syndrome: out of sight, out of mind? Neuropsychol Rev 2012; 22:81-92. [PMID: 22569770 PMCID: PMC3545191 DOI: 10.1007/s11065-012-9196-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/30/2012] [Indexed: 12/20/2022]
Abstract
Wernicke's Encephalopathy is an acute neuro-psychiatric condition caused by an insufficient supply of thiamine (Vitamin B1) to the brain. If undiagnosed or inadequately treated, it is likely to proceed to Korsakoff's Syndrome. Wernicke's Encephalopathy can result from dietary deficiency alone and this form is usually successfully treated, with little chance of Korsakoff's Syndrome supervening. On the other hand, thiamine deficiency associated with alcohol misuse/dependence may require up to 1 gram of thiamine IV in the first 24 hours to be treated successfully. The reasons for this difference in treatment will be discussed. Thiamine diphosphate acts as a co-factor for a number of thiamine-dependent enzymes. Thiamine deficiency leads to a reduction in the activity of these enzymes, and this leads to alterations in mitochondrial activity, impairment of oxidative metabolism, decreased energy status and eventually selective neuronal death. The damage caused by the combination of thiamine deficiency and alcohol metabolism probably interferes with adequate thiamine transport at a number of sites in the body, including the blood-brain barrier, as well as causing damage to the apoenzymes which then require higher concentrations of thiamine to work normally. The accumulated damage is likely to render the use of oral thiamine therapeutically inadequate since the body is unable to produce high enough concentrations of thiamine in the blood to traverse the blood-brain barrier. Some individuals are probably genetically predisposed to develop Wernicke's. Long before individuals with alcohol misuse or dependence develop Wernicke's Encephalopathy the neurons and other cells of the body are functioning sub-optimally because of the inadequate supply of thiamine and the neurotoxic effect of alcohol. This relative deficiency initiates a series of pathological changes which accumulate and further interfere with the supply of thiamine and its utilisation at a time when the requirements are increased. The best treatment for Korsakoff's Syndrome is timely recognition of Wernicke's Encephalopathy and appropriate intervention and prevention.
Collapse
|
93
|
Mrsić V, Adam VN, Velnić D, Matolić M, Stojcić EG, Barić M. [Wernicke's encephalopathy as a complication of bariatric surgery]. ACTA MEDICA CROATICA : CASOPIS HRAVATSKE AKADEMIJE MEDICINSKIH ZNANOSTI 2012; 66:17-22. [PMID: 23088081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Wernicke's encephalopathy is an acute, serious brain disorder resulting from thiamine deficiency, which is important as a cofactor in several enzymes associated with carbohydrate metabolism. The encephalopathy is most often associated with severe alcohol abuse, but thiamine deficiency can be caused by many other medical conditions. Bariatric surgery is listed among the causes of Wernicke's encephalopathy. This review provides a brief overview of the risk factors that cause thiamine deficiency, along with clinical features, diagnostic and therapeutic procedures important for timely recognition, therapy and prophylaxis of Wernicke's encephalopathy that occurs as a complication of bariatric surgery.
Collapse
|
94
|
Arana-Guajardo AC, Cámara-Lemarroy CR, Rendón-Ramírez EJ, Jáquez-Quintana JO, Góngora-Rivera JF, Galarza-Delgado DA. Wernicke encephalopathy presenting in a patient with severe acute pancreatitis. JOP : JOURNAL OF THE PANCREAS 2012; 13:104-107. [PMID: 22233960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/03/2012] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
CONTEXT Acute pancreatitis can lead to prolonged fasting and malnutrition. Many metabolic changes, including thiamine deficiency, may lead to the well know pancreatic encephalopathy. In this condition however the thiamine deficiency is rarely suspected. CASE REPORT We report the case of a 17-year-old woman with severe acute pancreatitis who developed mental status changes and ophthalmoplegia. A magnetic resonance image showed hyperintensive signals in periventricular areas, medial thalamus, and mammillary bodies, findings consistent with the diagnosis of Wernicke encephalopathy. Thiamine treatment reversed neurological complications. CONCLUSION Wernicke encephalopathy secondary to thiamine deficiency should be considered as a possible cause of acute mental status changes in patients with acute pancreatitis and malnutrition. Prophylactic doses of thiamine could be considered in susceptible patients.
Collapse
|
95
|
Anaforoğlu İ, Yildiz B, İnceçayir Ö, Algün E. A woman with thyrotoxicosis- and hyperemesis gravidarum-associated Wernicke's encephalopathy. NEURO ENDOCRINOLOGY LETTERS 2012; 33:285-289. [PMID: 22635085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
Although hyperthyroidism arising from primary thyroid disease is rare in pregnancy, transient gestational hyperthyroidism is not uncommon. This condition can be associated with hyperemesis gravidarum (HG), and Wernicke's encephalopathy. We present the case of a woman with toxic nodular goiter complicating HG-associated Wernicke's encephalopathy. A 38-year-old Caucasian woman, who had received a diagnosis of hyperthyroidism and HG early in her pregnancy, had intrauterine fetal death at Week 16 of gestation. One day after undergoing therapeutic abortion, she was admitted to our clinic with persistent thyrotoxicosis, nausea, and vomiting. A toxic thyroid nodule was detected. She was given antithyroid medication, total parenteral nutrition. On Day 10 of hospitalization, she developed ataxia, aphasia, and somnolence. Cranial magnetic resonance imaging showed increased bilateral thalamic signalization. She was given a diagnosis of Wernicke's metabolic encephalopathy, for which she received thiamine and multivitamin preparations. She responded dramatically on the second day of thiamine therapy. Her consciousness improved rapidly and she began to speak. Her muscle tone was slightly weak and she had paresthesias in both legs. Absorption of thiamine may be particularly impaired in pregnant women with hyperemesis and hyperthyroid disease. Wernicke's encephalopathy should be considered in hyperthyroid women with HG who develop neurological abnormalities.
Collapse
|
96
|
Goselink RJM, Harlaar JJ, Vermeij FH, Biter ULU, Mannaerts GHH, den Heijer T. [Beriberi after bariatric surgery]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2012; 155:A4500. [PMID: 22727224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED Bariatric surgery is in general the only effective treatment for morbid obesity. Bariatric surgery is frequently associated with vitamin and mineral deficiencies which may lead to neurological and other symptoms. We describe a case of severe vitamin B1 (thiamine) deficiency. CASE DESCRIPTION A 49-year-old man visited the emergency department with acute confusion, muscle weakness in arms and legs and visual impairment after a period of dysphagia and recurrent vomiting. Four months earlier, he had had bariatric gastric sleeve surgery for morbid obesity. Laboratory tests demonstrated that he had vitamin B1 deficiency, in view of which the diagnosis of beriberi and Wernicke encephalopathy was made. Despite normalisation of the vitamin B1 concentration following intravenous supplementation, the muscle strength hardly recovered and the patient developed Korsakov syndrome. CONCLUSION For this deficiency there is no other treatment than vitamin B1 supplementation. Timely recognition of vitamin deficiencies and pro-active supplementation are essential in order to prevent serious complications following bariatric surgery.
Collapse
|
97
|
D'Ettorre M, Rosa F, Coppola A, Mele C, Alfieri S, Doglietto GB. Postoperative suspected Wernicke's encephalopathy in a rectal cancer patient: a case report. J Palliat Care 2012; 28:290-292. [PMID: 23413765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
98
|
Basit S, Elsås T, Kvistad KA, Høsøien LS. Wernicke's encephalopathy because of pancreatitis in a young boy. Acta Ophthalmol 2011; 89:e656-7. [PMID: 21091939 DOI: 10.1111/j.1755-3768.2010.02033.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
99
|
D'Abbicco D, Praino S, Amoruso M, Notarnicola A, Margari A. "Syndrome in syndrome": Wernicke syndrome due to afferent loop syndrome. Case report and review of the literature. G Chir 2011; 32:479-482. [PMID: 22217376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Wernicke syndrome is a rare neurological pathology due to a deficit in vitamin B1. The syndrome is common among alcohol abusers, patients with malignant tumor or gastrointestinal diseases, those who undergo hemodialysis or long-term peritoneal dialysis, pregnant women with hyperemesis, women who breast-feed, patients with hyperthyroidism or anorexia nervosa or gastric or jejunal-ileal bypass surgery for obesity, patients submitted to gastric surgery or prolonged total parenteral nutrition or prolonged intravenous therapy. We report a case of Wernicke syndrome due to afferent loop syndrome characterized by incoercible vomiting.
Collapse
|
100
|
Luigetti M, Sabatelli M, Cianfoni A. Wernicke's encephalopathy following chronic diarrhoea. Acta Neurol Belg 2011; 111:257. [PMID: 22141298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|