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Zheng QH, Chen DC, Yue MX, Jing BW, Yang XY. [Wernicke encephalopathy induced by malnutrition in intensive care unit: a report of 1 case]. ZHONGGUO WEI ZHONG BING JI JIU YI XUE = CHINESE CRITICAL CARE MEDICINE = ZHONGGUO WEIZHONGBING JIJIUYIXUE 2011; 23:377. [PMID: 21672393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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102
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Sonkusare S. The clinical management of hyperemesis gravidarum. Arch Gynecol Obstet 2011; 283:1183-92. [PMID: 21424548 DOI: 10.1007/s00404-011-1877-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
Hyperemesis gravidarum is a severe and disabling condition with potentially life-threatening complications. It is likely to have a multifactorial etiology which contributes to the difficulty in treatment. Treatment is supportive with correction of dehydration and electrolyte disturbance, antiemetic therapy, prevention and treatment of complications like Wernicke's encephalopathy, osmotic demyelination syndrome, thromboembolism, and good psychological support. There are abundant data on the safety of antihistamines, phenothiazines, and metoclopromide in early pregnancy and treatment should therefore not be withheld on the basis of teratogenicity concerns. Thiamine replacement is indicated in hyperemesis gravidarum to prevent development of Wernicke's encephalopathy.
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Pereira DB, Pereira ML, Gasparetto EL. Nonalcoholic Wernicke encephalopathy with extensive cortical involvement: cortical laminar necrosis and hemorrhage demonstrated with susceptibility-weighted MR phase images. AJNR Am J Neuroradiol 2011; 32:E37-8. [PMID: 21233235 DOI: 10.3174/ajnr.a2359] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sequeira Lopes da Silva JT, Almaraz Velarde R, Olgado Ferrero F, Robles Marcos M, Pérez Civantos D, Ramírez Moreno JM, Luengo Pérez LM. Wernicke's encephalopathy induced by total parental nutrition. NUTR HOSP 2010; 25:1034-1036. [PMID: 21519777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/20/2010] [Indexed: 05/30/2023] Open
Abstract
Wernicke's encephalopathy is an acute neurological syndrome due to thiamine deficiency, which is characterized by a typical triad of mental status changes, oculomotor dysfunction and ataxia. Despite the fact that Wernicke's encephalopathy, in developed countries, is frequently associated with chronic alcoholism, there have been a number of published cases associating this encephalopathy with parenteral feeding without vitamin supplementation. Diagnosis is primarily a clinical one, and can be supported by laboratory tests and imaging studies; treatment should start as soon as possible, for the morbidity and mortality (almost 20%) associated with this syndrome is high. Thiamine supplementation, along with other vitamins, is recommended for patients in risk of developing this syndrome.
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Attia L, Houissa M, Chachia A, Ben Temime R, Makhlouf T, Sellami W, Jabri H, Kilani M, Saidi Y, Koubaa A. [Gayet-Wernicke encephalopathy secondary to pregnant vomiting]. LA TUNISIE MEDICALE 2010; 88:683-684. [PMID: 20812187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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107
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Damsgaard L, Ulrichsen J, Nielsen MK. [Wernicke's encephalopathy in patients with alcohol withdrawal symptoms]. Ugeskr Laeger 2010; 172:2054-2058. [PMID: 20615374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Wernicke's encephalopathy (WE) is caused by lack of thiamin. In Denmark, WE most often occurs in alcoholics. In the present study, we wanted to investigate the frequency of WE in patients hospitalized for treatment of alcohol withdrawal symptoms in a psychiatric emergency ward. MATERIAL AND METHODS Prospective registration of symptoms and treatment regimen in all patients admitted for alcohol withdrawal treatment in the period 22.02.2007-31.08.2008. RESULTS Symptoms of WE occurred in 52 of a total of 497 patients (11%). Ataxia of gait was the predominant symptom, succeeded by cognitive impairment, whereas ocular palsy was unusual. Patients with WE were on average administered approximately 50% more phenobarbital than patients without symptoms of WE (p < 0.01), probably reflecting a more severe withdrawal reaction. In 21 of the 52 patients with WE (41%) the preceding period of alcohol intake was shorter than 14 days. DISCUSSION WE is a frequently occurring condition among patients treated for alcohol withdrawal symptoms in psychiatric wards. A possible pathogenetic factor is the alcohol withdrawal reaction, as cerebral hyperactivity may lead to increased thiamin consumption and thus depletion of the depots. To avoid insufficient treatment, routine administration of large doses of intravenous thiamine to all patients admitted with alcohol withdrawal symptoms should be considered.
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Zhang KJ, Zhang HL, Zhang D, Wu J. Comments on "Wernicke's encephalopathy after laparoscopic Roux-en-Y gastric bypass: a misdiagnosed complication". Obes Surg 2010; 20:1329-30; author reply 1331. [PMID: 20526864 DOI: 10.1007/s11695-010-0207-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Niemann T, Erb S, Ott HW. [Confusion, gait ataxia and ophthalmoplegia in a patient with chronic alcohol consumption]. PRAXIS 2010; 99:311-313. [PMID: 20205089 DOI: 10.1024/1661-8157/a00054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Wernicke encephalopathy is a neurological disorder, often caused by a lack of thiamine. Immediate diagnosis and therapy are important to prevent significant morbidity and mortality. Based on a clinical case radiologic imaging features on MRI are demonstrated.
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Ba F, Siddiqi ZA. Neurologic complications of bariatric surgery. REVIEWS IN NEUROLOGICAL DISEASES 2010; 7:119-124. [PMID: 21206427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
With the rapid rise in the number of bariatric surgeries performed for morbid obesity, several short- and long-term neurologic complications of this procedure have been identified. These complications affect various levels of the neuraxis, and most are likely secondary to deficiency of essential minerals and vitamins. We report on 3 patients who developed unusual and severe neurologic deficits after undergoing bariatric surgery, including Wernicke encephalopathy, acute and rapidly progressive polyneuropathy, myelopathy, and visual deficits. Two developed clinical features of Parkinsonism, a complication not previously reported in this patient population. None of our patients had attended a nutrition clinic postoperatively. All 3 had a rapid weight loss and intractable vomiting preceding the development of neurologic symptoms, and all were found to have significant vitamin deficiencies. Replacement of vitamins resulted in a slow and variable degree of neurologic recovery. Patients undergoing bariatric surgery should have close monitoring of their nutritional status postoperatively. Routine supplementation of vitamins and minerals may be a cost-effective strategy for preventing neurologic complications in these patients.
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Brown J, McColm R, Aindow J, Anderson J. Nursing assessment and management of alcohol-related brain damage in young people. NURSING TIMES 2009; 105:20-23. [PMID: 19899490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The long term consequences of chronic alcohol misuse are increasingly affecting young people. This one part unit outlines the main signs and symptoms of Wernicke's encephalopathy and Korsakoff's syndrome. It details nursing assessment and management of these conditions, as well as regimens for safe detoxification.
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Schroeder M, Troëng T, Brattström L, Navne T. [Early complication following bariatric surgery. Wernicke encephalopathy in a 23-year old woman within three months after surgery]. LAKARTIDNINGEN 2009; 106:2216-2217. [PMID: 19817179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Ishiko T, Taguchi T, Takeguchi M, Saito H, Nanri K. [Case of Wernicke's encephalopathy and subacute combined degeneration of the spinal cord due to vitamin deficiency showing changes in the bilateral corpus striatum and cardiac arrest due to beriberi heart disease]. BRAIN AND NERVE = SHINKEI KENKYU NO SHINPO 2009; 61:1069-1073. [PMID: 19803406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 52-year-old woman was admitted to the hospital because of appetite loss, unsteadiness, psychogenic symptoms, ataxia, and consciousness disturbance as a result of the ingestion of a diet restricted to only carbohydrates for a long term. Laboratory examination indicated the presence of pancytopenia with macrocytic anemia; further, decreased vitamin B1 and B12 levels were detected in her serum. Magnetic resonance imaging fluid attenuated inversion recovery (FLAIR), revealed high-signal intensity in the bilateral corpus striatum, third ventricle circumference, and cerebellar cortex. Thereafter, she received drip infusion that did not include vitamin B1 or B12 and subsequently suffered a cardiac arrest due to the aggravation of cardiac insufficiency; consequently, she was transferred to our hospital. Upon admission the patient was diagnosed to have obvious cardiomegaly with pleural effusion; further, a negative T-wave was obtained on the electrocardiogram. A diagnosis of beriberi heart disease was made because of thiamine deficiency. She was treated by thiamine administration, following which the cardiac symptoms improved immediately. Various neurological symptoms caused by encephalopathy, peripheral neuropathy and subacute combined spinal cord degeneration improved by treatment with thiamine and cyanocobalamine administration; however, some of these symptoms still remained. General awareness of the fact that neurological symptoms can be caused by vitamin deficiency is essential.
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Abstract
PURPOSE To report a case of Wernicke encephalopathy after gastric bypass surgery resulting in vision loss, ophthalmoplegia, and ataxia, all of which reversed with a single dose of IV thiamine. METHODS Observational case report. RESULTS A 34-year-old woman presented with decreased vision and intermittent diplopia after gastric bypass surgery. She was found to have bilateral limitation of horizontal gaze, decreased vision with bilateral central scotoma and mild disc edema OU. Her cranial magnetic resonance imaging (MRI) was normal. A presumptive diagnosis of Wernicke encephalopathy was made. The patient was admitted, and a single dose of IV thiamine reversed the ophthalmoplegia and vision loss within 24 hours. CONCLUSION Wernicke encephalopathy should be considered in patients with vision loss after gastric bypass surgery. The classic triad of confusion, ataxia, and ophthalmoplegia may not be present and, although uncommon, the findings of optic disc edema and vision loss should not deter the clinician from making the diagnosis. Replacement thiamine if given promptly may rapidly reverse the findings.
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Zangheri E, Pigna A, Amanti E, D'Alessandro R, Bova F, Melotti RM, Di Nino G. Wernicke's encephalopathy and pancreatic encephalopathy after necrotic-hemorrhagic pancreatitis. A case report. Minerva Anestesiol 2009; 75:401-404. [PMID: 19182737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This case report describes a case of acute necrotic-hemorrhagic pancreatitis complicated by Wernicke's encephalopathy (WE) and stresses the importance of a correct dietetic regimen. A 39-year-old Chinese male patient with negative remote pathological anamnesis was hospitalized in the Medical Department with a diagnosis of gallstones. The clinical course was complicated with the onset of acute pancreatitis. Enteral fasting was imposed with intravenous feeding without vitamin supplementation. The progressive worsening of the clinical, radiodiagnostic and laboratory profile combined with deterioration in the state of consciousness promoted, on the 36th day exploratory laparotomy revealed necrotic-hemorrhagic pancreatitis. The patient was, therefore, admitted to the Intensive Care Unit in a deep coma. The recent medical history, neurological examination, and encephalic computed tomography suggested a revealing diagnosis of WE combined with pancreatic encephalopathy.
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Hansen B, Larsson C, Wirén J, Hallgren J. Hypothermia and infection in Wernicke's encephalopathy. ACTA MEDICA SCANDINAVICA 2009; 215:185-7. [PMID: 6702497 DOI: 10.1111/j.0954-6820.1984.tb04991.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Two cases of acute Wernicke's encephalopathy with severe hypothermia as the major presenting feature are reported. Treatment with thiamine was rapidly introduced, but hypothermia nevertheless persisted for several weeks, at times masked by intercurrent infections.
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Thomson AD, Jeyasingham MD, Pratt OE, Shaw GK. Nutrition and alcoholic encephalopathies. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 717:55-65. [PMID: 3478971 DOI: 10.1111/j.0954-6820.1987.tb13042.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An assessment has been made of metabolic factors possibly causing or contributing to the brain damage associated with chronic alcoholism, especially thiamin lack or disturbance of amino acid metabolism. Abnormalities in the thiamin-dependent enzyme, transketolase, provide evidence of a high incidence of thiamin deficiency as well as of disturbed thiamin metabolism in chronic alcoholics, which are likely to be caused by reduced vitamin intake as well as impaired absorption. A grossly disturbed pattern of amino acids in the blood of patients undergoing treatment for alcohol withdrawal syndromes is likely to be caused by loss of hepatic function and may well aggravate brain damage caused by B group vitamin deficiency. A hypothesis is proposed of how chronic thiamin lack can lead to brain damage.
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Butterworth RF. Thiamine deficiency-related brain dysfunction in chronic liver failure. Metab Brain Dis 2009; 24:189-96. [PMID: 19067139 DOI: 10.1007/s11011-008-9129-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 10/28/2008] [Indexed: 12/01/2022]
Abstract
End-stage chronic liver failure results in thiamine deficiency caused principally by depletion of liver thiamine stores. Chronic liver failure also leads to increased brain ammonia concentrations. Both ammonia and thiamine deficiency result in decreased activity of alpha-ketoglutarate dehydrogenase, a rate-limiting tricarboxylic acid cycle enzyme. Loss of enzyme activity results in a mitochondrial oxidative deficit in brain and consequent increases in brain lactate, oxidative/nitrosative stress, cellular energy impairment and release of proinflammatory cytokines, all of which have been described in brain in end-stage chronic liver failure. Synergistic effects of ammonia exposure and thiamine deficiency could explain the diencephalic and cerebellar symptomatology described in patients with "hepatic encephalopathy". Unsuspected brain lesions due to thiamine deficiency could explain the incomplete resolution of neuropsychiatric symptoms following the use of ammonia-lowering agents or liver transplantation in patients with end-stage chronic liver failure. These findings underscore the need for prompt, effective thiamine supplementation in all patients with chronic liver failure.
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Chamorro AJ, Marcos-Martin M, Martin-Polo J, Garcia-Diez LC, Luna G. Wernicke encephalopathy in alcoholics with diabetic ketoacidosis. Intern Med 2009; 48:1187-9. [PMID: 19571457 DOI: 10.2169/internalmedicine.48.2100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Wernicke encephalopathy is caused by thiamine deficiency in the central nervous system, and is defined by the triad of confusional symptoms, ocular alterations and ataxia. Some other factors may also predispose alcoholic patients to this deficiency. We report two patients with hyperglicaemia and ketoacidosis due to diabetes mellitus decompensation and chronic alcoholism who developed Wernicke encephalopathy before their hospital admission. The outcome was successful after intravenous thiamine administration and insulinotherapy. The presence of Wernicke encephalopathy in alcoholics with diabetic ketoacidosis, suggests that metabolic decompensation is essential in the onset of the disease.
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Watanabe S, Yamakura S, Hirano K, Okumura Y, Aiba H. [Case of infantile autism with pediatric Wernicke's encephalopathy due to severe eating disorder]. NO TO HATTATSU = BRAIN AND DEVELOPMENT 2009; 41:43-46. [PMID: 19172816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Wernicke's encephalopathy (WE) or thiamine deficiency is fatal if left untreated. We report a case of a 3-year-old boy with infantile autism and a severe eating disorder who developed WE after 3 weeks of starvation without thiamine supplementation. The eating disorder started when he entered preschool. He presented with unconsciousness and a cluster of seizures. Cranial magnetic resonance imaging (MRI) showed high-intensity signal changes in the basal ganglia on T2-weighted images and fluid-attenuated inversion recovery (FLAIR). Treatment with high-dose intravenous thiamine was effective. Pediatric patients with WE tends to show no typical symptoms or brain lesions on MRI as seen in adult WE patients typically along alcoholics. Brain lesions similar to those in hypoxia or mitochondrial diseases such as Leigh's encephalopathy, are observed in patients with pediatric WE, and this makes diagnosis difficult. WE should be considered when patients with severe eating disorders present with unconsciousness and/or frequent seizures, and show basal ganglia lesions on MRI, differential diagnosis should include WE.
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García Carreira C, Estela Herrero J, Ribera Perpinya G. [Wernicke-Korsakoff encephalopathy secondary to non-excessive vomiting]. Neurologia 2009; 24:75-77. [PMID: 19214822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Grunenwald S, Broussaud S, Vezzosi D, Bennet A, Larrue V, Caron P. Well-differentiated endocrine pancreatic tumour and Wernicke's encephalopathy. Clin Endocrinol (Oxf) 2009; 70:170-1. [PMID: 18616707 DOI: 10.1111/j.1365-2265.2008.03328.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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