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Turrini I, Guidetti C, Contaldo I, Pulitanò S, Rigante D, Veredice C. Wernicke Encephalopathy Caused by Avoidance-Restrictive Food Intake Disorder in a Child: A Case-Based Review. Diseases 2024; 12:112. [PMID: 38920544 PMCID: PMC11202895 DOI: 10.3390/diseases12060112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Wernicke encephalopathy (WE) is an acute and potentially fatal neuropsychiatric disorder resulting from thiamine deficiency: its etiology and clinical presentation can be heterogeneous and arduously recognized, especially in children and adolescents. CASE PRESENTATION An 8-year-old girl arrived to the emergency room with ataxic gait, nystagmus, and mental confusion after a 10-day history of repeated severe vomiting; her recent clinical history was characterized by restricted nutrition due to a choking phobia, which caused substantial weight loss. Brain magnetic resonance imaging revealed a bilaterally increased T2 signal in the medial areas of the thalami and cerebral periaqueductal region. Diagnosis of WE based on clinical and neuroradiological findings was established and confirmed after labwork showing low serum thiamine. Following psychiatric evaluation, the patient was also diagnosed with avoidance-restrictive food intake disorder (ARFID), which required starting cognitive behavioral therapy and introducing aripiprazole. The patient displayed improvement of the radiological findings after one month and complete resolution of her neurological symptoms and signs. CONCLUSIONS Eating disorders like ARFID might forerun acute signs of WE; this possibility should be considered even in pediatric patients, especially when atypical neurological pictures or feeding issues come out.
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Affiliation(s)
- Ida Turrini
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
| | - Clotilde Guidetti
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
| | - Ilaria Contaldo
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
| | - Silvia Pulitanò
- Pediatric Intensive Care Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Donato Rigante
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Veredice
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
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Basouny N, Spigos J, Khvolis D, McFarlane-Ferreira Y, Lee A. Wernicke Encephalopathy in a Pediatric Patient with Avoidant Restrictive Food Intake Disorder: A Rare Presentation of Thiamine Deficiency. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940717. [PMID: 37632134 PMCID: PMC10467509 DOI: 10.12659/ajcr.940717] [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: 04/11/2023] [Revised: 07/17/2023] [Accepted: 07/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Wernicke encephalopathy is traditionally associated with chronic alcoholism, nutritional imbalance, prolonged intravenous feeding, hyperemesis, anorexia nervosa, and malabsorption syndromes. We report a case of Wernicke's encephalopathy in a 12-year-old girl with avoidant restrictive food intake disorder. CASE REPORT The patient had lost 45.4 kg of body weight due to self-imposed changes to her diet, before presenting with decreased oral intake for 2-3 weeks, intermittent nausea, crampy epigastric pain, and post-prandial emesis. Her weight on admission was 78.2 kg. She received intravenous fluids of dextrose 5% with normal saline while she initially attempted to eat, but the post-prandial emesis persisted. She developed a fear of vomiting, which led to even more severe food intake restriction. After a week, she began to report double vision and blurred peripheral vision, with physical findings of nystagmus and an ataxic gait. She was empirically started on thiamine after negative neurology workup, with improvement of her gait, blurry vision, and nystagmus. Thiamine deficiency was later confirmed. CONCLUSIONS In patients with large amounts of weight loss presenting with neurological symptoms, Wernicke's encephalopathy must be considered in the differential diagnosis. Avoidant restrictive food intake disorder is rarely reported to cause Wernicke's encephalopathy. To the best of our knowledge, this is the first pediatric case demonstrating that Wernicke encephalopathy can occur in this type of eating disorder and not just in anorexia nervosa.
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Affiliation(s)
- Noha Basouny
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - John Spigos
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Dmitri Khvolis
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | | | - Ada Lee
- Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, NY, USA
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Suo H, Shishir MRI, Wang Q, Wang M, Chen F, Cheng KW. Red Wine High-Molecular-Weight Polyphenolic Complex Ameliorates High-Fat Diet-Induced Metabolic Dysregulation and Perturbation in Gut Microbiota in Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:6882-6893. [PMID: 37126594 DOI: 10.1021/acs.jafc.2c06459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Red wine polyphenolic complexes have attracted increasing attention as potential modulators of human metabolic disease risk. Our previous study discovered that red wine high-molecular-weight polymeric polyphenolic complexes (HPPCs) could inhibit key metabolic syndrome-associated enzymes and favorably modulate human gut microbiota (GM) in simulated colonic fermentation assay in vitro. In this work, the efficacy of HPPC supplementation (150 and 300 mg/kg/day, respectively) against high-fat diet (HFD)-induced metabolic disturbance in mice was investigated. HPPCs effectively attenuated HFD-induced obesity, insulin resistance, and lipid and glucose metabolic dysregulation and ameliorated inflammatory response and hepatic and colonic damage. It also improved the relative abundance of Bacteroidetes and Firmicutes, consistent with an anti-obesity phenotype. The favorable modulation of GM was further supported by improvement in the profile of fecal short-chain fatty acids. The higher dosage generally had a better performance in these effects than the low dosage. Moreover, serum metabolite profiling and pathway enrichment analysis revealed that HPPCs significantly modulated vitamin B metabolism-associated pathways and identified N-acetylneuraminic acid and 2-methylbutyroylcarnitine as potential biomarkers of the favorable effect on HFD-induced metabolic dysregulation. These findings highlight that dietary supplementation with red wine HPPCs is a promising strategy for the management of weight gain and metabolic dysregulation associated with HFD.
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Affiliation(s)
- Hao Suo
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
- Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
| | - Mohammad Rezaul Islam Shishir
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
- Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
| | - Qi Wang
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Mingfu Wang
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
- Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
| | - Feng Chen
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
- Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
| | - Ka Wing Cheng
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
- Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
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Solomon N, Sailer A, Dixe de Oliveira Santo I, Pillai A, Heng LXX, Jha P, Katz DS, Zulfiqar M, Sugi M, Revzin MV. Sequelae of Eating Disorders at Imaging. Radiographics 2022; 42:1377-1397. [PMID: 35930473 DOI: 10.1148/rg.220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although eating disorders are common, they tend to be underdiagnosed and undertreated because social stigma tends to make patients less likely to seek medical attention and less compliant with medical treatment. Diagnosis is crucial because these disorders can affect any organ system and are associated with the highest mortality rate of any psychiatric disorder. Because of this, imaging findings, when recognized, can be vital to the diagnosis and management of eating disorders and their related complications. The authors familiarize the radiologist with the pathophysiology and sequelae of eating disorders and provide an overview of the related imaging findings. Some imaging findings associated with eating disorders are nonspecific, and others are subtle. The presence of these findings should alert the radiologist to correlate them with the patient's medical history and laboratory results and the clinical team's findings at the physical examination. The combination of these findings may suggest a diagnosis that might otherwise be missed. Topics addressed include (a) the pathophysiology of eating disorders, (b) the clinical presentation of patients with eating disorders and their medical complications and sequelae, (c) the imaging features associated with common and uncommon sequelae of eating disorders, (d) an overview of management and treatment of eating disorders, and (e) conditions that can mimic eating disorders (eg, substance abuse, medically induced eating disorders, and malnourishment in patients with cancer). Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Anne Sailer
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Irene Dixe de Oliveira Santo
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Aishwarya Pillai
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Lauren Xuan Xin Heng
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Priyanka Jha
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Maria Zulfiqar
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Mark Sugi
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
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