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.

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.

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.

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.

A Case of Bilateral Ptosis with Unsteady Gait: Suggestibility and Culture in Conversion Disorder

2001 ◽  
Vol 31 (2) ◽  
pp. 225-232 ◽  
Author(s):  
Marwan M. Al-Sharbati ◽  
Noona Viernes ◽  
Ala'Adin Al-Hussaini ◽  
Ziad A. J. Zaidan ◽  
Pratap Chand ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Conversion Disorder ◽  
Sudden Onset ◽  
Gait Disturbance ◽  
Bilateral Ptosis ◽  
Unsteady Gait ◽  
One Year ◽  
Loss Of Appetite ◽  
Medical Examinations ◽  
Stimulation Of

We report a case of a 14-year-old girl who presented, following a sudden onset, with bilateral ptosis, gait disturbance, difficulty swallowing and loss of appetite, right hypochondriacal pain, and frontal headache. Protracted neurological and medical examinations were unremarkable; neither was precipitating psychological stresses evident. The condition, which manifest as typical conversion disorder, lasted for one year. “Treatment” involving electrical stimulation of both eyes muscles and legs with positive reassurance resolved the symptom. This case supports the view that conversion disorder, not only involves a strong element of suggestion, but also incorporates socio-cultural sanctioned prescription.

scholarly journals Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

2021 ◽  
Author(s):  
Nanako Koyama ◽  
Chikako Matsumura ◽  
Yuuna Tahara ◽  
Morito Sako ◽  
Hideo Kurosawa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Symptom Clusters ◽  
Rank Test ◽  
Appetite Loss ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Log Rank Test ◽  
Eortc Qlq ◽  
Cluster 2

Abstract Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

scholarly journals Prescription Opioids Dispensed to Patients with Cancer with Bone Metastasis: 2011‐2017

2021 ◽  
Author(s):  
Hao Zhang ◽  
Judith Paice ◽  
Russell Portenoy ◽  
Eduardo Bruera ◽  
M Carrington Reid ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Prescription Opioids ◽  
Patients With Cancer

scholarly journals Physiopathology of Spine Metastasis

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Giulio Maccauro ◽  
Maria Silvia Spinelli ◽  
Sigismondo Mauro ◽  
Carlo Perisano ◽  
Calogero Graci ◽  
...  
Keyword(s):  
Growth Factors ◽  
Bone Metastasis ◽  
Lymphatic System ◽  
Spinal Metastasis ◽  
Bone Destruction ◽  
The Body ◽  
Vicious Cycle ◽  
Patients With Cancer ◽  
Local Tumour ◽  
Neurological Injuries

The metastasis is the spread of cancer from one part of the body to another. Two-thirds of patients with cancer will develop bone metastasis. Breast, prostate and lung cancer are responsible for more than 80% of cases of metastatic bone disease. The spine is the most common site of bone metastasis. A spinal metastasis may cause pain, instability and neurological injuries. The diffusion through Batson venous system is the principal process of spinal metastasis, but the dissemination is possible also through arterial and lymphatic system or by contiguity. Once cancer cells have invaded the bone, they produce growth factors that stimulate osteoblastic or osteolytic activity resulting in bone remodeling with release of other growth factors that lead to a vicious cycle of bone destruction and growth of local tumour.

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.

Wernicke encephalopathy in a caregiver: A serious physical issue resulting from stress in a family member caring for an advanced cancer patient

2021 ◽  
pp. 1-3
Author(s):  
Mayumi Ishida ◽  
Nozomu Uchida ◽  
Akira Yoshioka ◽  
Izumi Sato ◽  
Tetsuya Hamaguchi ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Family Member ◽  
Advanced Cancer ◽  
Family Members ◽  
The Body ◽  
Mental Condition ◽  
Wernicke Encephalopathy ◽  
Level Of Consciousness ◽  
Loss Of Appetite ◽  
Burden Of Caring

Abstract Objective It is well known that the burden on the families of cancer patient extends across many aspects, but there have been no reports of family members developing delirium due to the burden of caring for a cancer patient. Methods We reported a caregiver who developed Wernicke encephalopathy (WE) while caring for a family member with advanced cancer. Results The subject was a 71-year-old woman who had been caring for her husband, diagnosed with gastric cancer and liver metastases, for 5 months. She visited the “caregivers’ clinic” after referral by an oncologist who was worried about a deterioration in her mental condition that had appeared several weeks previously. The woman had a history of diabetes mellitus. Some giddiness was observed and, based on her inability to answer questions, her level of consciousness was checked and some disorientation was observed. She was diagnosed with delirium. A blood sample was collected to investigate the cause of the delirium, but the test data showed no hypoglycemia. Her appetite had declined since her husband was diagnosed with cancer. Thiamine deficiency was suspected as thiamine stores in the body are depleted within about 18 days and her loss of appetite had continued for 5 months. On intravenous injection of 100 mg of thiamine, her consciousness level was returned to normal in 1 h. A diagnosis of WE was supported by the patient's abnormally low serum thiamine level. Significance of the results The family members of cancer patients may develop a loss of appetite due to the burden of caring, resulting in WE. When providing care for signs of distress in family members, it is necessary to pay attention not only to the psychological aspects but also to their level of consciousness and physical aspects, particularly the possibility of serious illness resulting from reduced nutritional status.

Laboratory and Bone Marrow Evaluation in Patients with Cancer

1998 ◽  
Vol 5 (2_suppl) ◽  
pp. 12-16 ◽  
Author(s):  
Lynn C. Moscinski
Keyword(s):  
Bone Marrow ◽  
Laboratory Findings ◽  
Patients With Cancer ◽  
Bone Marrow Evaluation ◽  
Bone Marrow Histopathology ◽  
Multiple Causes

Anemia in patients with cancer has multiple causes. Since establishing a diagnosis can be difficult, evaluation via laboratory findings and bone marrow histopathology is often necessary. Cytopenias can result either directly or indirectly from the malignancy, or they occasionally are the result of other causes, such as AIDS or infection.

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