scholarly journals Thiamine Deficiency With Mashed Potatoes: A Novel Case of Wernicke Encephalopathy Manifesting With Retinal Hemorrhages in a Pediatric Patient

Cureus ◽  
2020 ◽  
Author(s):  
Harmanpreet K Tiwana ◽  
Gerald Raymond ◽  
Kevin Littleton ◽  
Rishi Singhal ◽  
Ashutosh Kumar
Keyword(s):  
Pediatric Patient ◽  
Thiamine Deficiency ◽  
Wernicke Encephalopathy ◽  
Retinal Hemorrhages ◽  
Mashed Potatoes

Gayet-Wernicke encephalopathy with rapid evolution toward dementia in alcoholic dependence – case report

Psihiatru ro ◽  
2019 ◽  
Vol 58 (3) (1) ◽  
pp. 18-20
Author(s):  
Cătălina Crişan ◽  
Laura Grosu ◽  
Oana Vanţa
Keyword(s):  
Case Report ◽  
Thiamine Deficiency ◽  
Withdrawal Syndrome ◽  
Rapid Evolution ◽  
Full Recovery ◽  
Wernicke Encephalopathy ◽  
Korsakoff Syndrome ◽  
Dementia Syndrome ◽  
Patients Experience

Gayet-Wernicke encephalopathy is an acute neuropsychiatric condition caused by thiamine deficiency. Only a small percentage of patients experience all three symptoms, with ophtalmoplegia, ataxia and confusion, and the full triad occurs more frequently among those who have overused alcohol. The evolution is toward full recovery, Korsakoff syndrome, dementia or death. We present the case of a 56-year-old patient, known with a diagnostic of alcoholism, who was admitted for a complicated withdrawal syndrome with delirium and who developed encephalopathy and dementia syndrome.

Subclinical thiamine deficiency in patients with abdominal cancer

2017 ◽  
Vol 16 (4) ◽  
pp. 497-499 ◽  
Author(s):  
Hideki Onishi ◽  
Mayumi Ishida ◽  
Iori Tanahashi ◽  
Takao Takahashi ◽  
Yoshitada Taji ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Thiamine Deficiency ◽  
Storage Capacity ◽  
Clinical Symptoms ◽  
Performance Status ◽  
Clinical Signs ◽  
Medical Emergency ◽  
Wernicke Encephalopathy ◽  
Appetite Loss ◽  
Pancreatic Body Cancer

AbstractObjectiveThiamine is an essential coenzyme for oxidative metabolisms; however, it is not synthesized in the human body, and the average thiamine storage capacity is approximately 18 days. Therefore, thiamine deficiency (TD) can occur in any condition of unbalanced nutrition. If TD is left untreated, it causes the neuropsychiatric disorder Wernicke encephalopathy (WE). Although WE is a medical emergency, it is sometimes overlooked because most patients with WE do not exhibit all of the typical symptoms, including delirium, ataxia, and ophthalmoplegia. If all of the typical clinical symptoms of WE are absent, diagnosis of TD or WE becomes more difficult.MethodFrom a series of cancer patients, we reported three patients who developed TD without the typical clinical symptoms of WE.ResultA 69-year-old woman with pancreatic body cancer receiving chemotherapy with paclitaxel and gemcitabine for six months. Her performance status (PS) was 1. A detailed interview revealed that she had appetite loss for six months. Another 69-year-old woman with ovarian cancer received nedaplatin; her PS was 0. A detailed interview revealed that she had appetite loss for three months. A 67-year-old woman with colon cancer receiving ramucirumab in combination with second-line fluorouracil with folinic acid and irinotecan. Her PS was 1. A detailed interview revealed that she had appetite loss for three weeks. None exhibited typical clinical signs of WE, but they developed appetite loss for six months, three months, and three weeks, respectively. The diagnosis of TD was supported by abnormally low serum thiamine levels.Significance of the resultsThis report emphasizes the possibility of TD in cancer patients even when patients do not develop typical clinical signs of WE. The presence of appetite loss for more than two weeks may aid in diagnosing TD. Patients receiving chemotherapy may be at greater risk for developing TD.

scholarly journals Wernicke Encephalopathy in COVID-19 Patients: Report of Three Cases

2021 ◽  
Vol 12 ◽  
Author(s):  
Marcus Vinicius Branco de Oliveira ◽  
Daniel Galera Bernabé ◽  
Sergio Irikura ◽  
Rodrigo Batista Irikura ◽  
Antônio Mendes Fontanelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Thiamine Deficiency ◽  
Distress Syndrome ◽  
Wernicke Encephalopathy

Encephalopathy has been frequently reported in patients with acute respiratory distress syndrome (ARDS) related to COVID-19, and its etiology remains undetermined. These patients display hypercatabolic state, weight loss, use of diuretics, and dialytic therapy, which represent risk factors for thiamine depletion. The diagnosis of Wernicke encephalopathy (WE) is challenging and based on risk factors for the depletion of thiamine. We reported three cases of patients with COVID-19-related WE treated with intravenous thiamine. All patients responded with immediate neurologic improvement, and two of them had accelerated ventilatory weaning. The cases reported suggest that thiamine deficiency could represent relevant etiology of COVID-19-related encephalopathy.

scholarly journals Conversion of upbeat to downbeat nystagmus in Wernicke encephalopathy

Neurology ◽  
2018 ◽  
Vol 91 (17) ◽  
pp. 790-796 ◽  
Author(s):  
Jorge C. Kattah ◽  
Ali Saber Tehrani ◽  
Sascha du Lac ◽  
David E. Newman-Toker ◽  
David S. Zee
Keyword(s):  
Thiamine Deficiency ◽  
Linear Acceleration ◽  
Selective Vulnerability ◽  
High Dose ◽  
Downbeat Nystagmus ◽  
Wernicke Encephalopathy ◽  
Truncal Ataxia ◽  
Gaze Holding ◽  
Ataxia Syndrome ◽  
Vertical Nystagmus

ObjectiveTo explain (1) why an initial upbeat nystagmus (UBN) converts to a permanent downbeat nystagmus (DBN) in Wernicke encephalopathy (WE) and (2) why convergence and certain vestibular provocative maneuvers may transiently switch UBN to DBN.MethodsFollowing a literature review and study of our 2 patients, we develop hypotheses for the unusual patterns of vertical nystagmus in WE.ResultsOur overarching hypothesis is that there is a selective vulnerability and a selective recovery from thiamine deficiency of neurons within brainstem gaze-holding networks. Furthermore, since the circuits affected in WE are commonly paraventricular, especially medially, just under the floor of the fourth ventricle where lie structures important for control of vertical gaze, we suggest the patterns of involvement in WE also reflect a breakdown in vulnerable areas of the blood–brain barrier. Many of the initial deficits of our patients improved over time, but their DBN did not. Irreversible changes in paramedian tract neurons, which project to the cerebellar flocculus, may be the cause. Here we suggest that conversion of UBN to permanent DBN points to thiamine deficiency and may argue for a chronic, nonprogressive DBN/truncal ataxia syndrome. Finally, we posit that the transient switch of UBN to DBN reflects abnormal processing of otolith information about linear acceleration, and often points to a diagnosis of WE.ConclusionRecognizing the unusual patterns of transient switching and then permanent conversion of UBN to DBN in WE is vital since long-term disability from WE may be prevented by timely, parenteral high-dose thiamine.

scholarly journals Vestibular signs of thiamine deficiency during the early phase of suspected Wernicke encephalopathy

2013 ◽  
Vol 3 (6) ◽  
pp. 460-468 ◽  
Author(s):  
J. C. Kattah ◽  
S. S. Dhanani ◽  
J. H. Pula ◽  
G. Mantokoudis ◽  
A. S. S. Tehrani ◽  
...  
Keyword(s):  
Thiamine Deficiency ◽  
Early Phase ◽  
Wernicke Encephalopathy

Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy

2015 ◽  
Vol 14 (3) ◽  
pp. 302-306 ◽  
Author(s):  
Hideki Onishi ◽  
Mayumi Ishida ◽  
Hiroaki Toyama ◽  
Iori Tanahashi ◽  
Kenji Ikebuchi ◽  
...  
Keyword(s):  
Early Detection ◽  
Thiamine Deficiency ◽  
External Genitalia ◽  
Clinical Findings ◽  
Wernicke Encephalopathy ◽  
Appetite Loss ◽  
Irreversible Brain Damage ◽  
Laboratory Examinations ◽  
Loss Of Appetite ◽  
Thiamine Level

AbstractObjective:Few reports of Wernicke encephalopathy in oncological settings have been published. Some cases of Wernicke encephalopathy are related to appetite loss; however, the degree to which loss of appetite leads to thiamine deficiency is not known.Method:A 63-year-old female with advanced cancer of the external genitalia was referred for psychiatric consultation because of disorientation, insomnia, and bizarre behaviors. Her symptoms fulfilled the diagnostic criteria for delirium. Routine laboratory examinations did not reveal the cause of the delirium. Thiamine deficiency was suspected because appetite loss had continued for 19 days since she had been admitted to hospital.Results:Intravenous administration of thiamine resulted in recovery from the delirium within three days. Serum thiamine level was found to be 16 ng/ml (normal range: 24–66 ng/ml). The clinical findings, the low level of thiamine in the serum, and the effective alleviation of delirious symptoms after thiamine administration fulfilled Francis's criteria for delirium induced by thiamine deficiency.Significance of results:Clinicians must be aware of the possibility of Wernicke encephalopathy in cancer patients, especially in those with loss of appetite for longer than 18 days. The degree of appetite loss in such patients might serve as a reference. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab

2018 ◽  
Vol 17 (2) ◽  
pp. 245-247 ◽  
Author(s):  
Hideki Onishi ◽  
Mayumi Ishida ◽  
Hiroshi Kagamu ◽  
Yoshitake Murayama ◽  
Kunihiko Kobayashi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patient ◽  
Thiamine Deficiency ◽  
Lung Cancer Patient ◽  
Advanced Lung Cancer ◽  
Wernicke Encephalopathy ◽  
Laboratory Findings ◽  
Patients With Cancer ◽  
Cancer Trajectory ◽  
Loss Of Appetite

AbstractObjectiveWernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. It is recognized in various stages of the cancer trajectory but has not previously been recognized during nivolumab treatment.MethodFrom a series of WE patients with cancer, we report a lung cancer patient who developed WE during treatment with nivolumab.ResultA 78-year-old woman with lung cancer was referred to our psycho-oncology clinic because of depressed mood. Psychiatric examination revealed disorientation to time, date, and place, which had not been recognized 1 month previously. Her symptoms fulfilled the diagnostic criteria for delirium. No laboratory findings or drugs explaining her delirium were identified. WE was suspected as she experienced a loss of appetite lasting 4 weeks. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after intravenous thiamine administration.Significance of resultsWe found WE in an advanced lung cancer patient receiving treatment with nivolumab. Further study revealed the association between nivolumab and thiamine deficiency. Oncologists should consider thiamine deficiency when a patient experiences a loss of appetite of more than 2 weeks regardless of the presence or absence of delirium.

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