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Shepherd E, Smyth D, Sterenstein A, Dorsch A, Mizen T. Post-COVID Wernicke's presenting as bilateral vision loss. Am J Ophthalmol Case Rep 2022; 25:101271. [PMID: 35075437 PMCID: PMC8769919 DOI: 10.1016/j.ajoc.2022.101271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 07/05/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Emily Shepherd
- Corresponding author. Rush University Medical Center, 1725 W Harrison St Suit 906 Chicago, IL, 615-727-4076, USA.
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2
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Mashkovskiy E, Szawarski P, Ryzhkov P, Goslar T, Mrak I. Fulminant high altitude blindness. J Travel Med 2016; 23:taw057. [PMID: 27601532 DOI: 10.1093/jtm/taw057] [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] [Accepted: 08/08/2016] [Indexed: 11/13/2022]
Abstract
Prolonged altitude exposure even with acclimatization continues to present a physiological challenge to all organ systems including the central nervous system. We describe a case of a 41-year-old Caucasian female climber who suffered severe visual loss that was due to possible optic nerve pathology occurring during a high altitude expedition in the Himalayas. This case is atypical of classic high altitude cerebral oedema and highlights yet another danger of prolonged sojourn at extreme altitudes.
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Affiliation(s)
- Evgeny Mashkovskiy
- Lecturer of the Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Piotr Szawarski
- Wexham Park Hospital, Consultant in Intensive Care Medicine, Slough, UK
| | - Pavel Ryzhkov
- "The FIS Center" Ophthalmology Clinic, Moscow, Russia
| | - Tomaz Goslar
- Department of Intensive Care Medicine, University Medical centre Ljubljana, Zaloška 2, Ljubljana, 1000 Slovenija
| | - Irena Mrak
- College of Environmental Protection, Associate Prof. in Geography, Trg mladosti 7, Velenje 3320, Slovenia
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Abstract
Thiamine deficiency classically manifests as the triad of Wernicke encephalopathy: acute confusional state, ataxic gait, and ocular motor dysfunction. However, most patients do no present with this classic triad. Optic neuropathy in thiamine deficiency is a rare manifestation and is usually associated with fundus appearances of optic disc swelling or optic disc pallor. We present 2 unique cases of thiamine deficiency where the fundus demonstrated peripapillary retinal nerve fiber layer thickening without florid disc swelling or pallor.
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Straube A, Klein M, Erbguth F, Maschke M, Klawe C, Sander D, Hilz MJ, Ziemssen T, Klucken J, Kohl Z, Winkler J, Bettendorf M, Staykov D, Berrouschot J, Dörfler A. Metabolische Störungen. NEUROINTENSIV 2015. [PMCID: PMC7175475 DOI: 10.1007/978-3-662-46500-4_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Im folgenden Kapitel werden die verschiedenen metabolischen Störungen betrachtet. Zunächst wird auf die allgemeinen und spezifischen neurologischen Komplikationen bei Organtransplantation eingegangen. Dann geht es um die metabolischen Enzephalopathien: Störungen der Gehirntätigkeit bei angeborenen und erworbenen Stoffwechselerkrankungen im engeren Sinn, Elektrolytstörungen, Hypovitaminosen, zerebrale Folgen einzelner Organdysfunktionen, zerebrale Hypoxien, Endotheliopathien und Mitochondropathien. Anschließend werden das Alkoholdelir und die Wernicke-Enzephalopathie erörtert. Bei zahlreichen akuten Erkrankungen von Gehirn, Rückenmark und peripherem Nervensystem treten typische Störungen vegetativer Systeme auf, deren Erkennung und Therapie insbesondere bei Intensivpatienten eine vitale Bedeutung haben kann: die autonomen Störungen. Bei der zentralen pontinen Myelinolyse kommt es zu einer akuten, vorwiegend fokal-symmetrischen Demyelinisierung im Hirnparenchym. Auch Basalganglienerkrankungen können intensivmedizinisch relevant werden. Und schließlich wird die akute Stressreaktion betrachtet, die aufgrund der vielfältigen metabolischen und endokrinen Veränderungen bei kritischen Erkrankungen entsteht. Gerade das RCVS als neuere Krankheitsentität und wichtige Differenzialdiagnose zur Vaskulitis des ZNS verdient einen eigenen Platz, in diesem Unterkapitel werden ebenfalls verwandte Syndrome wie die hypertensive Enzephalopathie und das PRES abgehandelt.
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Beh SC, Frohman TC, Frohman EM. Neuro-ophthalmic Manifestations of Cerebellar Disease. Neurol Clin 2014; 32:1009-80. [DOI: 10.1016/j.ncl.2014.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Shin C Beh
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Abstract
PURPOSE OF REVIEW Toxic, nutritional, hereditary, traumatic, and neoplastic optic neuropathies result in significant disability due to visual dysfunction. Many of these conditions are treatable. Early diagnosis may allow for intervention to stabilize or improve vision and prevent unnecessary testing. These conditions have overlapping clinical features, and careful assessment of the visual system allows for accurate diagnosis and management. RECENT FINDINGS Newer treatment strategies are available for optic neuropathies previously thought untreatable, such as some hereditary optic neuropathies. Many conditions that previously were felt to represent distinct diseases can be linked by a common pattern of mitochondrial dysfunction. SUMMARY The optic nerve is susceptible to a wide variety of pathologic processes. The correct diagnosis depends on a thorough history and detailed evaluation of the visual system. Certain optic neuropathies selectively affect the papillomacular bundle, and particular attention to this location can considerably narrow the differential diagnosis and subsequent workup.
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Akçaboy ZN, Yağmurdur H, Baldemir R, Mutlu NM, Dikmen B. Wernicke's Encephalopathy After Longterm Feeding with Parenteral Nutrition. Turk J Anaesthesiol Reanim 2014; 42:96-9. [PMID: 27366398 DOI: 10.5152/tjar.2014.93695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/22/2013] [Indexed: 11/22/2022] Open
Abstract
Wernicke's encephalopathy occurs due to thiamine (vitamin B1) deficiency which is characterized by occulomotor dysfunction, confusion and ataxia. Although it is most common with alcoholism, can also be seen due to hyperemesis caused by chemotherapy, Crohn's disease, gastrointestinal system surgery, AIDS, bariatric surgery and longterm feeding with parenteral nutrition. In this case, a 51-year-old woman who was treated with longterm total parenteral nutrition due to hyperemesis and had the diagnosis of Wernicke's encephalopathy after admission to the intensive care unit is presented.
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Affiliation(s)
- Zeynep Nur Akçaboy
- Anaesthesiology and Reanimation Department C3 Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hatice Yağmurdur
- Anaesthesiology and Reanimation Department C3 Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ramazan Baldemir
- Anaesthesiology and Reanimation Department C3 Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Nevzat Mehmet Mutlu
- Anaesthesiology and Reanimation Department C3 Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Bayezit Dikmen
- Anaesthesiology and Reanimation Department C3 Intensive Care Unit, Ankara Numune Training and Research Hospital, Ankara, Turkey
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8
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Abstract
Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.
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Affiliation(s)
- Bikram S Bal
- Department of Medicine, Washington Hospital Center, POB North, Suite 3400, 106 Irving Street Northwest, Washington, DC 20010, USA
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9
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Zhang SQ, Guan YT. Acute bilateral deafness as the first symptom of Wernicke encephalopathy. AJNR Am J Neuroradiol 2012; 33:E44-5. [PMID: 22300936 DOI: 10.3174/ajnr.a3040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mroczkowski MM, Redgrave GW, Miller NR, McCoy AN, Guarda AS. Reversible vision loss secondary to malnutrition in a woman with severe anorexia nervosa, purging type, and alcohol abuse. Int J Eat Disord 2011; 44:281-3. [PMID: 20186722 DOI: 10.1002/eat.20806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report a case of severe reversible vision loss in a woman with a 7-year history of anorexia nervosa, purging type, alcohol abuse and a severely restricted, vitamin-deficient diet. METHOD Psychiatric, ophthalmologic, and medical records were reviewed, and a literature search was performed on visual complications associated with anorexia nervosa and malnutrition. DISCUSSION Ophthalmologic complications of malnutrition are rare but include both oculomotor and visual sensory disturbances. Thiamine deficiency can cause both types of disorders. Vitamin B12 and folate deficiencies are typically associated with optic neuropathy. Clinicians treating eating disorders should be aware of the potential for vitamin deficiencies and associated visual loss in patients with anorexia nervosa. This case highlights the importance of a detailed dietary history to guide vitamin rehabilitation and to minimize or reverse nutritional visual loss.
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Affiliation(s)
- Megan M Mroczkowski
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Irreversible Optic Neuropathy in Wernicke Encephalopathy and Leber Hereditary Optic Neuropathy. J Neuroophthalmol 2010; 30:49-53. [DOI: 10.1097/wno.0b013e3181ce80c6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Abstract
Optimal functioning of the central and peripheral nervous system is dependent on a constant supply of appropriate nutrients. The first section of this review discusses neurologic manifestations related to deficiency of key nutrients such as vitamin B(12), folate, copper, vitamin E, thiamine, and others. The second section addresses neurologic complications related to bariatric surgery. The third sections includes neurologic presentations caused by nutrient deficiencies in the setting of alcoholism. The concluding section addresses neurologic deficiency diseases that have a geographic predilection.
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Affiliation(s)
- Neeraj Kumar
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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