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.

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.

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.

Thiamine deficiency observed in a cancer patient's caregiver

2019 ◽  
Vol 17 (5) ◽  
pp. 611-613
Author(s):  
Hideki Onishi ◽  
Mayumi Ishida ◽  
Nozomu Uchida ◽  
Takao Takahashi ◽  
Daisuke Furuya ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Thiamine Deficiency ◽  
Detailed Examination ◽  
Care Providers ◽  
Psychological Issues ◽  
The Family ◽  
Hospital Visits ◽  
One Year ◽  
Loss Of Appetite ◽  
Thiamine Level

AbstractObjectiveThiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer; however, TD has not been recognized in the family caregivers of cancer patients to date.MethodFrom a series of cancer patient caregivers, we reported an aged family caregiver who developed TD while caring for the cancer patient.ResultThe caregiver was a 90-year-old male. He had been accompanying his wife, who was diagnosed with colon cancer 4 years previously, on hospital visits as the primary caregiver, but because of psychological issues, he was recommended to visit the psycho-oncology department's “caregiver's clinic” for a consultation. Detailed examination revealed that his appetite had been only about 50% of usual from about one year before, and he had lost 12 kg in weight in one year. The diagnosis of TD was supported by his abnormally low serum thiamine level.Significance of the resultsThis report demonstrates that there is a possibility that care providers could develop TD from the burdens associated with caregiving. TD should be considered whenever there is a loss of appetite lasting for more than 2 weeks, and medical staff should pay careful attention to the physical condition of care providers to prevent complications resulting from TD.

Thiamine deficiency in the bereaved after cancer-related spousal loss

2019 ◽  
Vol 17 (6) ◽  
pp. 738-740
Author(s):  
Hideki Onishi ◽  
Nozomu Uchida ◽  
Takao Takahashi ◽  
Daisuke Furuya ◽  
Yasuhiro Ebihara ◽  
...  
Keyword(s):  
Thiamine Deficiency ◽  
Detailed Examination ◽  
Hypopharyngeal Cancer ◽  
Loved One ◽  
Spousal Loss ◽  
One Year ◽  
After Cancer ◽  
Loss Of Appetite ◽  
Thiamine Level ◽  
Low Serum

AbstractObjectiveThiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer. However, it has not been recognized to date in bereaved partners after spousal loss from cancer.MethodFrom a series of bereaved partners who lost a spouse to cancer, we report on those who developed TD after bereavement.ResultCase 1 was a 57-year-old woman who sought consultation at our “bereavement clinic.” Her husband had been diagnosed with pancreatic cancer one year earlier and had died one month previously. At the first visit, she was observed to suffer depression, anxiety, and decreased appetite. Neurological, blood, and biochemical examinations did not reveal any noteworthy findings. She was diagnosed with uncomplicated bereavement. Detailed examination revealed that her appetite had been markedly decreased for approximately five weeks. The diagnosis of TD was supported by her abnormally low serum thiamine level. Case 2 was a bereaved 73-year-old male who had lost his wife to hypopharyngeal cancer one month previously after a five-year illness. He had shown a lack of energy for the month preceding his wife's death, but because there was no improvement after her death, his family recommended he seek consultation at our “bereavement clinic.” He was suffering from major depressive disorder. Detailed examination revealed that his appetite had been decreased for more than two weeks. Again, the diagnosis of TD was supported by his abnormally low serum thiamine level.Significance of resultsThese reports demonstrate that there is a possibility that bereaved could develop TD after the loss of a loved one. TD should be considered whenever there is a loss of appetite lasting for more than 2 weeks, and medical staff should pay careful attention to the physical condition of the bereaved to prevent complications because of TD.

Wernicke encephalopathy without delirium in patients with cancer

2017 ◽  
Vol 16 (1) ◽  
pp. 118-121 ◽  
Author(s):  
Hideki Onishi ◽  
Mayumi Ishida ◽  
Iori Tanahashi ◽  
Takao Takahashi ◽  
Yoshitada Taji ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Gait Disturbance ◽  
Wernicke Encephalopathy ◽  
Appetite Loss ◽  
Laboratory Findings ◽  
Patients With Cancer ◽  
Non Hodgkin Lymphoma ◽  
Outpatient Visits ◽  
Unsteady Gait ◽  
Loss Of Appetite

ABSTRACTObjective:Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. Several reports of WE in cancer patients are known. WE is sometimes overlooked because most patients do not exhibit its typical symptoms (e.g., delirium, ataxia, ocular palsy). If delirium is not present, a diagnosis of WE is difficult because delirium is the hallmark symptom of WE.Method:Taken from a series on WE in cancer, we report two patients who developed WE without delirium during periodic psycho-oncology outpatient visits.Results:Case 1. A 61-year-old woman with non-Hodgkin lymphoma who was periodically attending a psycho-oncology outpatient clinic developed an unsteady gait. WE was suspected because she also developed appetite loss for two weeks, and we could find no other laboratory findings to explain her unsteady gait. Our diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after intravenous thiamine administration. Case 2. A 50-year-old woman with breast carcinoma with bone metastasis developed an unsteady gait. WE was suspected because she also developed loss of appetite for two weeks, and no other laboratory findings could explain her unsteady gait. The diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after administration of intravenous thiamine.Significance of Results:Our report emphasizes the importance of being aware of WE, even when patients do not present with delirium. The presence of loss of appetite for more than two weeks may be the key to a diagnosis of WE.

scholarly journals A Case of Wernicke Encephalopathy in a Dementia Caregiver: the Need for Nutritional Evaluation in Family Caregivers

2020 ◽  
Author(s):  
Mayumi Ishida ◽  
Nozomu Uchida ◽  
Kumi Itami ◽  
Izumi Sato ◽  
Akira Yoshioka ◽  
...  
Keyword(s):  
Thiamine Deficiency ◽  
The Body ◽  
Dementia Patient ◽  
Wernicke Encephalopathy ◽  
Case Presentation ◽  
Dementia Caregiver ◽  
Ocular Symptoms ◽  
Psychiatric Outpatient Clinic ◽  
The Family ◽  
Loss Of Appetite

Abstract Background: We report a case in which a family member caring for her mother with dementia developed Wernicke encephalopathy, which is a neuropsychiatric disorder caused by acute/subacute thiamine deficiency, during the course of care. Case presentation: A 63-year-old woman consulted our psychiatric outpatient clinic complaining of difficulty in providing care. She had started caring for her mother with dementia 6 months previously, during which time she began to feel tired. In addition, a loss of appetite had appeared 2 months prior to her visit, and this had decreased to about 30% of normal from 10 days previously. Neurologically, she experienced mild unsteadiness, but she was fully conscious and had no ocular symptoms. Based on the fact that the store of thiamine in the body is exhausted in about 18 days, the possibility of thiamine deficiency was considered, and her unsteadiness disappeared after an intravenous injection of thiamine. Test results showed her serum thiamine level to be abnormally low, and the patient was diagnosed with Wernicke encephalopathy. Conclusions: The burden of caring for a dementia patient may affect the nutritional status of the family caregiver. Thiamine deficiency should be one of the items considered as a nutritional issue in such caregivers.

Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: A case report and review of the literature

2005 ◽  
Vol 3 (4) ◽  
pp. 337-340 ◽  
Author(s):  
HIDEKI ONISHI ◽  
YUKIO SUGIMASA ◽  
CHIAKI KAWANISHI ◽  
MASANARI ONOSE
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Cancer Patients ◽  
Brain Damage ◽  
Postoperative Delirium ◽  
Laboratory Data ◽  
Wernicke Encephalopathy ◽  
Irreversible Brain Damage ◽  
Thiamine Level ◽  
Lower Limit Of Normal

Objective: Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients.Methods: In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected.Results and significance of the research: In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Wernicke encephalopathy without delirium that appeared as agitation in a patient with lung cancer

2018 ◽  
Vol 16 (6) ◽  
pp. 800-802 ◽  
Author(s):  
Hideki Onishi ◽  
Mayumi Ishida ◽  
Takao Takahashi ◽  
Yoshitada Taji ◽  
Kenji Ikebuchi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Symptoms ◽  
Accurate Diagnosis ◽  
Type Result ◽  
Wernicke Encephalopathy ◽  
Appetite Loss ◽  
Laboratory Findings ◽  
Type Method ◽  
Patients With Cancer ◽  
Loss Of Appetite

AbstractObjectiveWernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency, and is sometimes overlooked because of the diversity of clinical symptoms.MethodFrom a series of WE patients with cancer, we report a lung cancer patient who developed WE, the main symptom of which was agitation.ResultA 50-year-old woman with lung cancer was referred to our psycho-oncology clinic because of agitation lasting for three days. No laboratory findings or drugs explaining her agitation were identified. Although the patient did not develop delirium, ophthalmoplegia, or ataxia, WE was suspected because she experienced a loss of appetite loss lasting 5 weeks. This diagnosis was supported by abnormal serum thiamine and disappearance of agitation one hour after intravenous thiamine administration.Significance of resultsThis report emphasizes the clinical diversity of WE and indicates the limits of the ability to diagnose WE from typical clinical symptoms. The presence of a loss of appetite for more than two weeks may be the key to the accurate diagnosis of WE.

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.

scholarly journals SARS-COV-2 transmission among family members

2020 ◽  
Vol 26 (3) ◽  
pp. 143-148
Author(s):  
Gordana Todorović ◽  
Aleksandar Joldžić ◽  
Slađana Anđelić ◽  
Darko Nedeljković
Keyword(s):  
Case Reports ◽  
Family Members ◽  
Clinical Findings ◽  
Rt Pcr ◽  
Laboratory Findings ◽  
Indirect Contact ◽  
Protein Levels ◽  
The World ◽  
High Erythrocyte Sedimentation Rate ◽  
Loss Of Appetite

Introduction/Objective Severe acute respiratory distress syndrome caused by coronavirus 2 (SARS-COV-2) is a new respiratory disease -COVID-19. A virus from the Coronaviridae family, highly contagious and virulent took over the world in a very short time causing the 2019/2020 pandemic. We are presenting the case of COVID-19 transmission among family members, patients of various ages, sex, clinical presentation and findings, who have been infected in different ways. Case reports Three patients are described, all with different coronavirus-specific symptomatology. Symptoms ranged from fatigue and loss of appetite with no other, more prominent symptoms in the youngest patient, to fever, high temperature, diarrhoea, muscle ache and chest pain during inspiration in the oldest patient. The third patient's dominant symptoms were dry, non-productive cough, lack of oxygen, shortness of breath and perspiration on exertion, headache and normal temperature, with radiographically confirmed bilateral pneumonia. Laboratory findings (leukopenia, lymphocytopenia with elevated C-reactive protein levels, high erythrocyte sedimentation rate and lactate dehydrogenase levels) were consistent with a viral infection, highly suspicious of SARS-COV-2, which was confirmed with a real-time RT-PCR test in all three patients. After being hospitalized in the Clinical Hospital Center "Zemun" Department of Pulmonology and treated with symptomatic, antiviral and antibiotic therapy, the disease regressed and the RT-PCR tests became negative. Conclusion SARS-COV-2 is a very aggressive and potent cause of the coronavirus disease. The presented cases confirm the possibility of quick transmission within a family through direct and indirect contact, as well as the diversity of symptoms, laboratory and clinical findings. Our clinical examples are similar in symptomatology and available results to cases from other parts of the world hit with the pandemic.

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