Atypical neuroleptic malignant syndrome and non-alcoholic Wernicke’s encephalopathy

2021 ◽  
Vol 14 (8) ◽  
pp. e244082
Author(s):  
Esther Shan Lin Hor ◽  
Gurpreet Pal Singh ◽  
Nurul Akhmar Omar ◽  
Vincent Russell
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Kidney Injury ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose ◽  
Fluphenazine Decanoate ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Atypical Presentations ◽  
High Index Of Suspicion

We report the case of a middle-aged woman with a history of bipolar disorder, in the absence of alcohol or substance misuse. The patient had been maintained on fluphenazine decanoate depot and now presented acutely with cognitive dysfunction and rigidity. Laboratory tests revealed elevated creatine kinase, acute kidney injury with metabolic acidosis and transaminitis, leading to a provisional diagnosis of neuroleptic malignant syndrome (NMS). Neuroleptics were withheld; dialysis was commenced; and blood biochemistry parameters improved in tandem. However, mental status changes persisted, and re-evaluation revealed multidirectional nystagmus with bilateral past-pointing. MRI confirmed the diagnosis of Wernicke’s encephalopathy (WE). Prompt recovery followed treatment with high-dose intravenous thiamine. We discuss the co-occurrence of NMS and non-alcoholic WE—highlighting the need for a high index of suspicion for these relatively rare neuropsychiatric diagnoses which are often missed in those with atypical presentations.

scholarly journals Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription

2017 ◽  
Vol 5 ◽  
pp. 2050313X1769599 ◽  
Author(s):  
Thomas J Reilly ◽  
Sean Cross ◽  
David M Taylor ◽  
Richard Haslam ◽  
Sophie C Tomlin ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Adverse Drug Reaction ◽  
Pulmonary Embolism ◽  
Neuroleptic Malignant Syndrome ◽  
Kidney Injury ◽  
Clinical Suspicion ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Intravenous Fluids ◽  
Life Threatening

Objectives: To describe a case of neuroleptic malignant syndrome following antipsychotic treatment of catatonia, highlighting the potentially serious complications of this rare adverse drug reaction. Methods: We present a case report of a patient who developed this syndrome with various sequelae. Results: The patient developed neuroleptic after being treated with lorazepam and olanzapine for catatonia. He subsequently developed the complications of rhabdomyolysis, acute kidney injury, pulmonary embolism, urinary retention and ileus. He received high-dose lorazepam, anticoagulation and intravenous fluids. Antipsychotic medication in the form of haloperidol was reinstated with no adverse effect, and he went on to make a full recovery. Conclusions: This case illustrates the potential life-threatening complications of neuroleptic malignant syndrome and the need for a low index of clinical suspicion. It also highlights the lack of evidence for treatment of catatonia, including the use of antipsychotics.

scholarly journals Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

2019 ◽  
Vol 12 (1) ◽  
pp. e227412 ◽  
Author(s):  
Timothy Xin Zhong Tan ◽  
Kheng Choon Lim ◽  
Charles Chan Chung ◽  
Than Aung
Keyword(s):  
Thiamine Deficiency ◽  
Kidney Injury ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Good Effect ◽  
Diagnostic Dilemma ◽  
Sensorimotor Polyneuropathy ◽  
Signal Abnormality ◽  
Loss Of Weight ◽  
Medical Emergencies

A 56-year-old teetotaller man with hypertension and gout presented with a week duration of painless worsening diplopia on a background of loss of weight and appetite, generalised lethargy and weakness for 1 year. On examination, he was noted to be hypothermic and tachycardic with generalised muscle wasting. Proximal myopathy, lower limb fasciculations and areflexia, restricted bilateral eye abduction and nystagmus were observed. Blood investigations demonstrated compensated lactic acidosis, acute kidney injury and leucocytosis. A nerve conduction study showed severe length-dependent axonal sensorimotor polyneuropathy. This was a diagnostic dilemma until an MRI brain revealed symmetrical signal abnormality and enhancement in the periaqueductal area indicative of Wernicke’s encephalopathy, caused by thiamine deficiency from poor nutrition. Beriberi, also caused by thiamine deficiency, accounted for his tachycardia, polyneuropathy, areflexia, hypothermia and biochemical abnormalities. Both beriberi and Wernicke’s encephalopathy are medical emergencies, which were treated with intravenous thiamine to good effect.

Stability of high-dose thiamine in parenteral nutrition for treatment of patients with Wernicke's encephalopathy

2020 ◽  
Vol 39 (9) ◽  
pp. 2929-2932
Author(s):  
Maciej Stawny ◽  
Aleksandra Gostyńska ◽  
Rafał Olijarczyk ◽  
Anna Jelińska ◽  
Magdalena Ogrodowczyk
Keyword(s):  
Parenteral Nutrition ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose

scholarly journals Wernicke’s Encephalopathy after Pancreaticoduodenectomy: A Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 1-7 ◽  
Author(s):  
Kazuteru Monden ◽  
Hiroshi Sadamori ◽  
Masayoshi Hioki ◽  
Satoshi Ohno ◽  
Mitsue Rikimaru ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Pancreatic Fistula ◽  
Thiamine Deficiency ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose ◽  
Blood Gas ◽  
Laboratory Test Results

Background: Wernicke’s encephalopathy (WE) is caused by thiamine deficiency and classically appears as changes in mental status, oculomotor manifestations, and gait ataxia. WE is mostly found in patients with chronic alcoholism and malnutrition, and has rarely been reported following pancreaticoduodenectomy. Case Presentation: A 77-year-old woman was admitted to our hospital complaining of loss of appetite and weakness of the lower extremities. No abnormalities were found on blood examination. One year earlier, she had undergone pancreaticoduodenectomy for bile duct cancer, and pancreatic fistula developed as a postoperative complication. On hospital day 8, her level of consciousness deteriorated, and she experienced difficulty bending the lower limbs and walking. Computed tomography and upper gastrointestinal series showed dilatation of the residual stomach and stenosis of the gastrojejunostomy. Laboratory test results were normal except for blood gas analysis, which revealed severe lactic acidosis. A diagnosis of WE was suspected due to lactic acidosis secondary to thiamine deficiency. Definitive diagnosis was confirmed by magnetic resonance imaging of the brain. Intravenous infusion of high-dose thiamine (1,200 mg/day) was commenced, leading to improvement of her neurological condition. Conclusions: Physicians should recognize that pancreaticoduodenectomy, when complicated by gastrojejunostomy stenosis resulting in pancreatic fistula, can lead to WE. In this case, blood gas analysis was helpful in arriving at the correct diagnosis. A high degree of suspicion should be maintained if any of the classical features of WE are observed following pancreaticoduodenectomy.

Treatment of Wernicke’s encephalopathy with high dose of thiamine in a patient with pyloric sub-stenosis: description of a case

2010 ◽  
Vol 31 (6) ◽  
pp. 859-861 ◽  
Author(s):  
Francesca Caso ◽  
A. Fiorino ◽  
M. Falautano ◽  
L. Leocani ◽  
V. Martinelli ◽  
...  
Keyword(s):  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose

scholarly journals High-dose Parenteral Thiamine in Treatment of Wernicke’s Encephalopathy: Case Series and Review of the Literature

In Vivo ◽  
2017 ◽  
Vol 31 (1) ◽  
pp. 121-124 ◽  
Author(s):  
ANDREW NISHIMOTO ◽  
JUSTIN USERY ◽  
JOHN C WINTON ◽  
JENNIFER TWILLA
Keyword(s):  
Case Series ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose ◽  
Review Of The Literature

scholarly journals Polymorphic Ventricular Tachycardia Associated with High-Dose Methadone Use

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Weng-Chio Tam ◽  
U-Po Lam ◽  
Toi-Meng Mok ◽  
Tou Chang ◽  
Wa Ho ◽  
...  
Keyword(s):  
Qt Interval ◽  
Normal Limit ◽  
Torsade De Pointes ◽  
Qt Prolongation ◽  
Polymorphic Ventricular Tachycardia ◽  
High Dose ◽  
Cardiac Side Effects ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Artery Disease

Methadone is a well-tolerated drug that has been used for pain control and the treatment of opioid addiction. However, some fatal cardiac side effects have been reported previously, including ventricular arrhythmia, stress cardiomyopathy, and coronary artery disease. We reported a middle-aged woman receiving high-dose methadone whom was presented with QT prolongation and torsade de pointes. We replaced the methadone with benzodiazepine and gave lidocaine use simultaneously. Thus, QT interval was shortened within the normal limit. Methadone-induced torsade de pointes is a rare but serious event, and QT interval should be monitored periodically to prevent this fatal adverse event, especially some patients with high-dose methadone use.

Uterine intravenous leiomyomatosis with femoral vein, intracaval, intracardiac and pulmonary artery extension

2020 ◽  
Vol 16 (1) ◽  
pp. 27-32
Author(s):  
Oluwaseun A Akinseye ◽  
Mannu Nayyar ◽  
Pranab Das
Keyword(s):  
Pulmonary Artery ◽  
Femoral Vein ◽  
Vena Cava ◽  
Right Atrial ◽  
Atrial Mass ◽  
Aged Woman ◽  
Right Atrial Mass ◽  
Progesterone Receptor Positivity ◽  
Middle Aged Woman ◽  
High Index Of Suspicion

We report a 54-year-old female with recently diagnosed multiple cardiac thrombi and pulmonary embolism that was treated with thrombolytics and anticoagulants. She presented again with worsening dyspnea and was found to have persistent large cardiac thrombi on echocardiogram. Surgical findings revealed a single right atrial mass originating from inferior vena cava and extending into the pulmonary artery. The mass was successfully removed. Final pathology revealed a benign smooth muscle and vascular mass with estrogen and progesterone receptor positivity favoring uterine intravenous leiomyoma. She was discharged on warfarin and leuprolide therapy. This diagnosis requires a high index of suspicion, especially in a middle-aged woman with right atrial mass and history of an existing leiomyoma, hysterectomy or myomectomy.

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