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Hiraga A, Kojima K, Kuwabara S. Typical and atypical MRI abnormalities in Wernicke's encephalopathy: Correlation with blood vitamin B1 levels. J Neurol Sci 2024; 461:123045. [PMID: 38749282 DOI: 10.1016/j.jns.2024.123045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Clinical features of Wernicke's encephalopathy (WE) confirmed strictly through the low blood vitamin B1 (VB1) levels are limited. This study aimed to analyse magnetic resonance imaging (MRI) findings, and clinical characteristics, in patients with WE who have confirmed low blood VB1 levels. METHODS Clinical and laboratory records of 12 consecutive patients with WE admitted to our hospital during the past 11 years were reviewed. The WE diagnosis was confirmed based on low blood VB1 levels and the presence of at least one of the classical triad. RESULTS Ophthalmoplegia and nystagmus were recorded in 75% and 50% of the patients, respectively. Eleven of 12 patients presented with consciousness disturbance/memory loss. All patients experienced gait disturbances. Eight of the 12 patients exhibited MRI abnormalities at typical sites (the dorsal midbrain [n = 7], medial thalamus [n = 6], mammillary bodies [n = 5], and dorsal pons [n = 5]). Of the 12 patients, six showed abnormalities at atypical sites (the splenium of the corpus callosum [n = 4], fornix [n = 3], cerebral cortex [n = 2], cerebellar vermis [n = 2], and dorsal medulla [n = 1]). Patients with positive MRI abnormalities had significantly lower blood VB1 levels than those without abnormalities (9.5 vs. 16.0 ng/mL). CONCLUSIONS In cases of confirmed WE with low blood VB1 levels, the corpus callosum, fornix, and cerebral cortex were more frequently involved than in previous studies. MRI abnormalities at both typical and atypical sites were correlated with low blood VB1 levels in WE, suggesting that lower blood VB1 levels are associated with more severe brain damage in patients with WE.
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Affiliation(s)
- Akiyuki Hiraga
- Department of Neurology, Chiba Rosai Hospital, Chiba, Japan.
| | - Kazuho Kojima
- Department of Neurology, Chiba Rosai Hospital, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Thompson A, Richardson P, Pirmohamed M, Owens L. Alcohol-related brain injury: An unrecognized problem in acute medicine. Alcohol 2020; 88:49-53. [PMID: 32502599 DOI: 10.1016/j.alcohol.2020.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
Alcohol-related brain injury (ARBI) is an unrecognized and therefore untreated consequence of alcohol use disorder. Here, we explore a 12-month period prevalence of alcohol-related brain injury (ARBI) in alcohol use disorder patients. Inpatients aged ≥18 years reviewed by the Alcohol Care Team's Specialist Nurses between April 1, 2017 and March 31, 2018 were eligible for the study (n = 1276). Screening identified a high-risk subset of patients who matched at least one of the following: 1) more than three alcohol-related admissions in one year; 2) two alcohol-related admissions in any given 30-day period; 3) patient or their significant other had concerns regarding cognition. The high-risk patients were assessed for evidence of ARBI using the Montreal Cognitive Assessment Tool (MoCA). The primary measure of interest was MoCA ≤23. Analysis was conducted between subgroups of the study population to identify prevalence rate ratios for matching the high-risk screening criteria, and MoCA ≤23 in high-risk patients. Two hundred and five patients were identified as high risk for ARBI. The period prevalence rates in this high-risk group for patients with a MoCA ≤23 was 36.1%. Those under the age of 35 years were significantly less likely to match the high-risk criteria. Patients that were homeless or staying in hostels were more likely to match the high-risk criteria and were also at increased risk of MoCA ≤23, compared with those living with family members. In summary, ARBI is common in patients with AUD attending acute hospitals. ARBI is often not diagnosed, and thus further work is required to improve screening for, and identification of, these patients to develop evidence-based clinical pathways that optimize care.
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Affiliation(s)
- Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom.
| | - Paul Richardson
- Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom; Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, United Kingdom
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom
| | - Lynn Owens
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom; Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, United Kingdom
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Oudman E, Wijnia JW, Oey M, van Dam M, Painter RC, Postma A. Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 236:84-93. [DOI: 10.1016/j.ejogrb.2019.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022]
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Segobin S, Ritz L, Lannuzel C, Boudehent C, Vabret F, Eustache F, Beaunieux H, Pitel A. Integrity of white matter microstructure in alcoholics with and without Korsakoff's syndrome. Hum Brain Mapp 2015; 36:2795-808. [PMID: 25873017 PMCID: PMC6869167 DOI: 10.1002/hbm.22808] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 12/11/2022] Open
Abstract
Alcohol dependence results in two different clinical forms: "uncomplicated" alcoholism (UA) and Korsakoff's syndrome (KS). Certain brain networks are especially affected in UA and KS: the frontocerebellar circuit (FCC) and the Papez circuit (PC). Our aims were (1) to describe the profile of white matter (WM) microstructure in FCC and PC in the two clinical forms, (2) to identify those UA patients at risk of developing KS using their WM microstructural integrity as a biomarker. Tract-based spatial statistics and nonparametric voxel-based permutation tests were used to compare diffusion tensor imaging (DTI) data in 7 KS, 20 UA, and 14 healthy controls. The two patient groups were also pooled together and compared to controls. k-means classifications were then performed on mean fractional anisotropy values of significant clusters across all subjects for two fiber tracts from the FCC (the middle cerebellar peduncle and superior cerebellar peduncle) and two tracts from the PC (fornix and cingulum). We found graded effects of WM microstructural abnormalities in the PC of UA and KS. UA patients classified at risk of developing KS using fiber tracts of the PC from DTI data also had the lowest scores of episodic memory. That finding suggests that WM microstructure could be used as a biomarker for early detection of UA patients at risk of developing KS.
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Affiliation(s)
- Shailendra Segobin
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
| | - Ludivine Ritz
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
| | - Coralie Lannuzel
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
| | - Céline Boudehent
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
- Centre Hospitalier Universitaire, Service D'addictologieCaenFrance
| | - François Vabret
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
- Centre Hospitalier Universitaire, Service D'addictologieCaenFrance
| | - Francis Eustache
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
| | - Hélène Beaunieux
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
| | - Anne‐Lise Pitel
- INSERMCaenFrance
- Université De Caen Basse‐NormandieCaenFrance
- Ecole Pratique Des Hautes EtudesCaenFrance
- Centre Hospitalier UniversitaireCaenFrance
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Laothamatas J, Sammet CL, Golay X, Van Cauteren M, Lekprasert V, Tangpukdee N, Krudsood S, Leowattana W, Wilairatana P, Swaminathan SV, DeLaPaz RL, Brown TR, Looareesuwan S, Brittenham GM. Transient lesion in the splenium of the corpus callosum in acute uncomplicated falciparum malaria. Am J Trop Med Hyg 2014; 90:1117-1123. [PMID: 24615139 PMCID: PMC4047739 DOI: 10.4269/ajtmh.13-0665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/07/2014] [Indexed: 02/05/2023] Open
Abstract
Patients with acute uncomplicated Plasmodium falciparum malaria have no evident neurologic disorder, vital organ dysfunction, or other severe manifestations of infection. Nonetheless, parasitized erythrocytes cytoadhere to the endothelium throughout their microvasculature, especially within the brain. We aimed to determine if 3 Tesla magnetic resonance imaging studies could detect evidence of cerebral abnormalities in these patients. Within 24 hours of admission, initial magnetic resonance imaging examinations found a lesion with restricted water diffusion in the mid-portion of the splenium of the corpus callosum of 4 (40%) of 10 male patients. The four patients who had a splenial lesion initially had evidence of more severe hemolysis and thrombocytopenia than the six patients who had no apparent abnormality. Repeat studies four weeks later found no residua of the lesions and resolution of the hematologic differences. These observations provide evidence for acute cerebral injury in the absence of severe or cerebral malaria.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sornchai Looareesuwan
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute of Neurology, University College London, London, United Kingdom; Philips Healthcare, Best, The Netherlands; The Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Departments of Radiology and Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Gary M. Brittenham
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute of Neurology, University College London, London, United Kingdom; Philips Healthcare, Best, The Netherlands; The Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Departments of Radiology and Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
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Kotha VK, De Souza A. Wernicke's encephalopathy following Hyperemesis gravidarum. A report of three cases. Neuroradiol J 2013; 26:35-40. [PMID: 23859165 DOI: 10.1177/197140091302600106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 01/27/2013] [Indexed: 01/16/2023] Open
Abstract
Wernicke's encephalopathy (WE) due to causes other than chronic alcohol abuse is an uncommon and often misdiagnosed condition. In the setting of hyperemesis gravidarum, an acute deficiency of thiamine results from body stores being unable to meet increased metabolic demands. The condition produces typical clinical and radiological findings and when diagnosed early and treated promptly has a good prognosis. Magnetic resonance imaging (MRI) is sensitive and specific for diagnosis. We describe three patients with hyperemesis gravidarum who developed WE, and highlight a range of clinical and imaging features important for appropriate diagnosis. A high degree of clinical suspicion is essential. Treatment is often empirical pending results of investigation, and consists of parenteral repletion of thiamine stores. Reversal of MRI findings parallels clinical improvement. Neurologic outcomes are usually good, but half the pregnancies complicated by this condition do not produce healthy children.
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Affiliation(s)
- V K Kotha
- Goa Medical College; Panaji, Goa, India.
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Abstract
One of the sequelae of chronic alcohol abuse is malnutrition. Importantly, a deficiency in thiamine (vitamin B(1)) can result in the acute, potentially reversible neurological disorder Wernicke encephalopathy (WE). When WE is recognized, thiamine treatment can elicit a rapid clinical recovery. If WE is left untreated, however, patients can develop Korsakoff syndrome (KS), a severe neurological disorder characterized by anterograde amnesia. Alcohol-related brain damage (ARBD) describes the effects of chronic alcohol consumption on human brain structure and function in the absence of more discrete and well-characterized neurological concomitants of alcoholism such as WE and KS. Through knowledge of both the well-described changes in brain structure and function that are evident in alcohol-related disorders such as WE and KS and the clinical outcomes associated with these changes, researchers have begun to gain a better understanding of ARBD. This Review examines ARBD from the perspective of WE and KS, exploring the clinical presentations, postmortem brain pathology, in vivo MRI findings and potential molecular mechanisms associated with these conditions. An awareness of the consequences of chronic alcohol consumption on human behavior and brain structure can enable clinicians to improve detection and treatment of ARBD.
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Affiliation(s)
- Natalie M Zahr
- Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford University, Stanford, CA 94305, USA
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He J, Overstreet DH, Crews FT. Abstinence from moderate alcohol self-administration alters progenitor cell proliferation and differentiation in multiple brain regions of male and female P rats. Alcohol Clin Exp Res 2008; 33:129-38. [PMID: 19076732 DOI: 10.1111/j.1530-0277.2008.00823.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute and chronic ethanol exposure has been found to decrease hippocampal neurogenesis, reduce dendritic differentiation of new neurons, and increase cell death. Interestingly, abstinence from such treatment increases hippocampal neurogenesis and microglial genesis across several brain regions. The goal of the current investigation was to study cellular alterations on neuro- and cell-genesis during abstinence following alcohol self-administration using alcohol-preferring rats (P rats). METHODS Male and female P rats were given the choice of drinking 10% alcohol in water or pure water for 7 weeks. Social interaction behavioral assessments were conducted at 5 hours upon removal of alcohol, followed by bromo-deoxyuridine (BrdU, 150 mg/kg x 1/d x 14 d) injections to label proliferating cells. Animals were then killed 4 weeks later to conduct immunohistochemical and confocal analyses using antibodies against BrdU and other phenotypic markers (NeuN for mature neurons; Iba-1 for microglia; GFAP for astrocytes; and NG(2) for oligodendrocyte progenitors). RESULTS Mild alcohol withdrawal anxiety was detected by reduction in social interactions. The number of hippocampal BrdU(+) cells was increased approximately 50% during alcohol abstinence (26 +/- 2.8 in controls vs. 39 +/- 4 in alcohol group). BrdU(+) cells were also increased in the substantia nigra (SN) approximately 65% in the alcohol abstinent group (12 +/- 1 in controls vs. 19 +/- 1.5 in alcohol group). No gender differences were found. Confocal analyses indicated that approximately 75% of co-localization of BrdU(+) cells with NeuN in the hippocampal dentate gyrus (DG) resulting a net increase in neurogenesis in the alcohol abstinent group compared to controls. In cingulum, greater proportion of BrdU(+) cells were co-localized with NG(2) in the alcohol abstinent group indicating increased differentiation toward oligodendrocyte progenitors in both genders. However, the phenotype of the BrdU(+) cells in SN and other brain regions were not identified by NeuN, Iba-1, GFAP, or NG(2) suggesting that these BrdU(+) cells probably remain in a nondifferentiated stage. CONCLUSIONS These data indicate that abstinence from moderate alcohol drinking increases hippocampal neurogenesis, cingulate NG(2) differentiation, and SN undifferentiated cell proliferation in both males and females. Such cellular alteration during abstinence could contribute to the spontaneous partial restoration of cognitive deficits upon sobriety.
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Affiliation(s)
- Jun He
- Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7178, USA
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Rosenbloom MJ, Sassoon SA, Fama R, Sullivan EV, Pfefferbaum A. Frontal Callosal Fiber Integrity Selectively Predicts Coordinated Psychomotor Performance in Chronic Alcoholism. Brain Imaging Behav 2008; 2:74-83. [PMID: 19606265 PMCID: PMC2709859 DOI: 10.1007/s11682-007-9017-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION: Quantitative fiber tracking with diffusion tensor imaging (DTI) provides a new approach for assessing deficits in the microstructural integrity of white matter circuits that may underlie cognitive deficits associated with conditions affecting white matter, including chronic alcoholism. METHODS: Alcoholic men and women (n=87) and healthy controls (n=88) performed the Digit Symbol (DS) test and underwent structural and diffusion tensor imaging. Measures of fractional anisotropy (FA) of fibers passing through genu and splenium were computed, as were size of genu and splenium fiber target regions of interest (ROI). RESULTS: Alcoholics scored lower than controls on the DS and had even greater deficits in genu than splenium fiber FA. In alcoholics, fiber FA of the genu selectively predicted DS scores after accounting for splenium FA. Neither fiber FA measure predicted incidental recall of the symbols used in the task. Size of genu and splenium ROI, although reduced in alcoholics, did not predict DS score or incidental recall. CONCLUSIONS: Quantitative tractography of frontal fibers connecting left and right hemispheres selectively predicted performance by alcoholics on a coordinated psychomotor task and provide support for frontally based systems in Digit Symbol performance, both of which are compromised in recovering alcoholics.
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Affiliation(s)
- Margaret J. Rosenbloom
- Neuroscience Program, SRI International, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5723, USA
| | | | - Rosemary Fama
- Neuroscience Program, SRI International, Menlo Park, CA, USA
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5723, USA
| | - Adolf Pfefferbaum
- Neuroscience Program, SRI International, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5723, USA
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