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Hiraga A, Kuwabara S. Hand knob sign in Wernicke's encephalopathy. Acta Neurol Belg 2023:10.1007/s13760-023-02326-7. [PMID: 37391683 DOI: 10.1007/s13760-023-02326-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Akiyuki Hiraga
- Department of Neurology, Chiba Rosai Hospital, 2-16 Tatsumidai-Higashi, Ichihara-shi, Chiba, 290-0003, Japan.
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Koca O, Demir B, Derin S, Turna ZH. A case report of Wernicke Korsakoff syndrome in a patient with cholangiocellular carcinoma: An underestimated cause of encephalopathy in cancer patients. Medicine (Baltimore) 2022; 101:e31904. [PMID: 36482648 PMCID: PMC9726370 DOI: 10.1097/md.0000000000031904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Wernicke's encephalopathy, a disorder caused by thiamin deficiency, is characterized by a classical triad of encephalopathy, ataxia, and ophthalmoplegia. Although alcoholism is the most common predisposing factor, it can also be associated with nonalcoholic states (hyperemesis gravidarum, intestinal obstruction, bariatric surgery, and others). This work presents a case of nonalcoholic Wernicke-Korsakoff syndrome diagnosed in a cholangiocellular carcinoma patient and literature review. CASE REPORT A 65-year-old male patient with a history of cholangiocellular carcinoma (Klatskin tumor) was treated with radiotherapy at the operation site after Roux-en-Y hepaticojejunostomy. During follow-up, the patient developed gastric outlet obstruction and was diagnosed with peritoneal carcinomatosis after a palliative gastrojejunostomy. As the patient could not tolerate oral nutrition during hospitalization, total parenteral nutrition was administered. After 10 days of admission, the patient showed decreased response to verbal stimuli as well as bilateral horizontal nystagmus, lethargy, and disorientation. Furthermore, the patient displayed confabulation. Clinical and imaging findings were consistent with Wernicke's encephalopathy. Therefore, treatment with intravenous thiamin replacement was initiated. The patient's encephalopathy regressed on the second day after treatment, and he recovered the place-person-time orientation. In the following month, the abnormal imaging findings were almost entirely resolved. CONCLUSION In order to prevent irreversible brain damage induced by chronic thiamin deficiency, thiamin replacement therapy with parenteral nutrition solutions should be included as a treatment for hospitalized cancer patients unable to receive enteral nutrition for a long time.
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Affiliation(s)
- Oguzhan Koca
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bilal Demir
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sumeyra Derin
- Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Hande Turna
- Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Moya M, López-Valencia L, García-Bueno B, Orio L. Disinhibition-Like Behavior Correlates with Frontal Cortex Damage in an Animal Model of Chronic Alcohol Consumption and Thiamine Deficiency. Biomedicines 2022; 10:biomedicines10020260. [PMID: 35203470 PMCID: PMC8869694 DOI: 10.3390/biomedicines10020260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 12/23/2022] Open
Abstract
Wernicke-Korsakoff syndrome (WKS) is induced by thiamine deficiency (TD) and mainly related to alcohol consumption. Frontal cortex dysfunction has been associated with impulsivity and disinhibition in WKS patients. The pathophysiology involves oxidative stress, excitotoxicity and inflammatory responses leading to neuronal death, but the relative contributions of each factor (alcohol and TD, either isolated or in interaction) to these phenomena are still poorly understood. A rat model was used by forced consumption of 20% (w/v) alcohol for 9 months (CA), TD hit (TD diet + pyrithiamine 0.25 mg/kg, i.p. daily injections the last 12 days of experimentation (TDD)), and both combined treatments (CA+TDD). Motor and cognitive performance and cortical damage were examined. CA caused hyperlocomotion as a possible sensitization of ethanol-induced excitatory effects and recognition memory deficits. In addition, CA+TDD animals showed a disinhibited-like behavior which appeared to be dependent on TDD. Additionally, combined treatment led to more pronounced alterations in nitrosative stress, lipid peroxidation, apoptosis and cell damage markers. Correlations between injury signals and disinhibition suggest that CA+TDD disrupts behaviors dependent on the frontal cortex. Our study sheds light on the potential disease-specific mechanisms, reinforcing the need for neuroprotective therapeutic approaches along with preventive treatments for the nutritional deficiency in WKS.
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Affiliation(s)
- Marta Moya
- Department of Psychobiology and Methods in Behavioral Sciences, Faculty of Psychology, Complutense University of Madrid (UCM), 28223 Madrid, Spain; (M.M.); (L.L.-V.)
- Red de Trastornos Adictivos (RTA), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Leticia López-Valencia
- Department of Psychobiology and Methods in Behavioral Sciences, Faculty of Psychology, Complutense University of Madrid (UCM), 28223 Madrid, Spain; (M.M.); (L.L.-V.)
| | - Borja García-Bueno
- Departament of Pharmacology and Toxicology, Faculty of Medicine, Complutense University of Madrid (UCM), 28040 Madrid, Spain;
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Instituto Universitario de Investigación en Neuroquímica IUIN-UCM, Avda. Complutense s/n, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Laura Orio
- Department of Psychobiology and Methods in Behavioral Sciences, Faculty of Psychology, Complutense University of Madrid (UCM), 28223 Madrid, Spain; (M.M.); (L.L.-V.)
- Red de Trastornos Adictivos (RTA), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence:
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A Fortunate Escape After Falling into a Ravine: a Case of Wernicke Encephalopathy, Polyneuropathy and Optic Neuropathy Following Sleeve Gastrectomy. Obes Surg 2021; 31:4174-4177. [PMID: 33977397 DOI: 10.1007/s11695-021-05471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
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Asiri AA, Aljarallah SA, Alayed KM. Polyneuropathy and Korsakoff syndrome complicating sleeve gastrectomy. Obes Res Clin Pract 2021; 15:293-296. [PMID: 33934996 DOI: 10.1016/j.orcp.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
We report a case of a 36 year old gentleman presenting with polyneuropathy and Korsakkoff Syndrome complicating Sleeve Gastrectomy.
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Affiliation(s)
- Alanood A Asiri
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Salman A Aljarallah
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Alayed
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Benzalim M, Arharas S, Alj S, Elouardi Y, Khallouki M. Gayet Wernicke's encephalopathy with cortical damage following a subtotal gastrectomy: An uncommon association. Radiol Case Rep 2020; 16:94-97. [PMID: 33204379 PMCID: PMC7649599 DOI: 10.1016/j.radcr.2020.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022] Open
Abstract
Wernicke's encephalopathy is a pathological entity caused by Vitamin B1 (Thiamine) deficiency in malnourished individuals, especially alcoholics, patients operated for digestive surgery or suffering from gastrointestinal tract's diseases or incoercible vomiting. Classically it manifests by confusion with oculomotor disorders and ataxia. However, other neurological manifestations are possible. Magnetic resonance imaging is the gold standard imaging technique for diagnosis. It shows signal abnormality on periventricular area around the third and fourth ventricles and on mammillary bodies in the most common cases, however other localizations are possible, in particular the cerebral cortex, which can explain the occurrence of epileptic seizures in some patients. Early administration of Thiamine, intravenously or intramuscularly, allows ad-integrum recovery, while delayed treatment is associated with serious consequences in terms of mortality and morbidity with debilitating neurological sequelae. The presence of cortical lesions is of poor prognosis despite a well-managed treatment. In this article, we report a nonalcoholic Wernicke's encephalopathy case, following a subtotal gastrectomy. Epileptic seizures were the major clinical manifestation, related to the associated cortical lesions. Despite early and well-managed treatment, the patient had a poor prognosis, with progression, after one month, to a persistent chronic vegetative state.
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Affiliation(s)
- Meriam Benzalim
- Department of Radiology, Ibn Tofail Hospital, Mohammed VI University Hospital Center, CADI AYYAD University, Faculty of Medicine and Pharmacy of Marrakech, Abdelouahab Derraq street, Marrakech 40000, Morocco
| | - Soumaya Arharas
- Department of Radiology, Ibn Tofail Hospital, Mohammed VI University Hospital Center, CADI AYYAD University, Faculty of Medicine and Pharmacy of Marrakech, Abdelouahab Derraq street, Marrakech 40000, Morocco
| | - Soumaya Alj
- Department of Radiology, Ibn Tofail Hospital, Mohammed VI University Hospital Center, CADI AYYAD University, Faculty of Medicine and Pharmacy of Marrakech, Abdelouahab Derraq street, Marrakech 40000, Morocco
| | - Youssef Elouardi
- Department of Anesthesia and Intensive Care Medicine, Ibn Tofail Hospital, Mohammed VI University Hospital Center, CADI AYYAD University, Faculty of Medicine and Pharmacy of Marrakech, Marrakech, Morocco
| | - Mohamed Khallouki
- Department of Anesthesia and Intensive Care Medicine, Ibn Tofail Hospital, Mohammed VI University Hospital Center, CADI AYYAD University, Faculty of Medicine and Pharmacy of Marrakech, Marrakech, Morocco
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WERNICKE ENCEPHALOPATHY IN A PATIENT WITH GASTRIC CANCER RECURRENCE AFTER UPPER GASTROINTESTINAL SURGERY: A CASE REPORT AND REVIEW OF THE LITERATURE. Gastroenterol Nurs 2020; 43:463-469. [PMID: 33259433 DOI: 10.1097/sga.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fedeli P, Justin Davies R, Cirocchi R, Popivanov G, Bruzzone P, Giustozzi M. Total parenteral nutrition-induced Wernicke's encephalopathy after oncologic gastrointestinal surgery. Open Med (Wars) 2020; 15:709-713. [PMID: 33336027 PMCID: PMC7712225 DOI: 10.1515/med-2020-0210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/31/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke's disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke's encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke's encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke's encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke's encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.
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Affiliation(s)
| | - Richard Justin Davies
- Department of General Surgery, Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - Paolo Bruzzone
- Dipartimento di Chirurgia Generale e Specialistica “Paride Stefanini”, Sapienza Università di Roma, Rome, Italy
| | - Michela Giustozzi
- Department of Medicine, Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy
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Liu YL, Xiao WM, Liang MQ, Wu ZQ, Wang YZ, Qu JF, Chen YK. Clinical characteristics and magnetic resonance imaging findings in nine patients with nonalcoholic Wernicke's encephalopathy: a retrospective study. Neuropsychiatr Dis Treat 2019; 15:2433-2441. [PMID: 31692555 PMCID: PMC6716582 DOI: 10.2147/ndt.s217237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/03/2019] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Wernicke's encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency. The most common cause of WE is alcoholism. However, there is a significant paucity of information in the existing literature relating to nonalcoholic WE. In this study, we investigated the clinical characteristics and neuroimaging findings of nine patients with nonalcoholic WE. PATIENTS AND METHODS We retrospectively collated clinical data from nine patients who had been diagnosed with WE in accordance with established criteria including age, gender, risk factors and clinical manifestations. We also collated initial hematological and neuroimaging findings. RESULTS The mean age of the nine patients was 54.0±17.1 years; four of these patients (44.4%) were male. All nine patients had a history of fasting (range, 5-47 days) prior to WE. Four of the nine patients (44.4%) exhibited the classical triad, and eight (88.9%) showed alterations in mental status. Magnetic resonance imaging (MRI) scans showed that all nine patients had symmetric lesions of the medial thalamus. MRI also revealed other WE-related lesions in mammillary bodies (22.2%), the periaqueductal region (55.6%), the tectal plate of the midbrain (77.8%), cranial nerve nuclei (77.8%) and in the symmetric subcortical white matter (11.1%). CONCLUSION Our analysis showed that fasting is a common cause of WE in nonalcoholic patients and that MRI is a useful tool for the diagnosis of WE. The most common MRI findings were symmetrical lesions of the medial thalamus lesions, followed by the tectal plate of the midbrain and cranial nerve nuclei.
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Affiliation(s)
- Yong-Lin Liu
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Wei-Min Xiao
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Man-Qiu Liang
- Department of Radiology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Zhi-Qiang Wu
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Ya-Zhi Wang
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Jian-Feng Qu
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Yang-Kun Chen
- Department of Neurology, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
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