Wernicke’s encephalopathy

2017 ◽  
Vol 10 (11) ◽  
pp. 660-666
Author(s):  
Sue May Liow
Keyword(s):  
Sulfuric Acid ◽  
Late Complication ◽  
Vitamin B1 ◽  
Memory Loss ◽  
Altered Mental Status ◽  
Chronic Alcoholism ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Common Presentation ◽  
Vitamin B1 Deficiency

Wernicke’s encephalopathy occurs as a result of thiamine (vitamin B1) deficiency. It was originally described by German neurologist Karl Wernicke in 1881 who observed the three cardinal features of Wernicke’s in two men with chronic alcoholism and a young woman who had ingested sulfuric acid and suffered prolonged episodes of vomiting. The three cardinal features are ophthalmoplegia, ataxia and confusion. It is largely undiagnosed, due to its vague presentation. Patients often present with confusion or altered mental status; a common presentation in those who might be intoxicated. The classic triad of symptoms described in textbooks is rarely seen. If not promptly or adequately treated Korsakoff’s syndrome, a late complication can develop, resulting in memory loss, confabulation and, ultimately, death.

scholarly journals Wernicke’s encephalopathy: An uncommon complication from hyperemesis gravidarum

2019 ◽  
Vol 13 (4) ◽  
pp. 198-200
Author(s):  
Roshan Shah ◽  
Isabelle Malhamé ◽  
Mariam Fayek ◽  
Alisa Merolli ◽  
Niharika Mehta
Keyword(s):  
Hyperemesis Gravidarum ◽  
Vitamin B1 ◽  
Wernicke’S Encephalopathy ◽  
Nutritional Deficiencies ◽  
Wernicke's Encephalopathy ◽  
Gait Ataxia ◽  
Severe Nausea ◽  
Neurologic Manifestation ◽  
Vitamin B1 Deficiency ◽  
Uncommon Complication

Hyperemesis gravidarum is a complication of pregnancy associated with severe nausea and vomiting that can lead to fluid-electrolyte imbalances and nutritional deficiencies. Wernicke’s encephalopathy is a neurologic manifestation of acute thiamine (vitamin B1) deficiency. We describe a case of hyperemesis gravidarum presenting with gait ataxia and nystagmus which led to a diagnosis of Wernicke’s encephalopathy.

scholarly journals Wernicke’s Encephalopathy with Normal Neuroimaging - Suspect and Treat - A Case Report

2021 ◽  
Vol 10 (33) ◽  
pp. 2867-2869
Author(s):  
Abhijit Wadekar ◽  
Sanyukta Hepat ◽  
Anamika Giri ◽  
Sourya Acharya
Keyword(s):  
Dietary Intake ◽  
Thiamine Deficiency ◽  
Cell Function ◽  
Neuronal Cell ◽  
Altered Mental Status ◽  
Chronic Alcoholism ◽  
Water Soluble ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Refeeding Syndrome

Wernicke’s encephalopathy (WE) is an unrecognized nutritional deficiency which often goes unnoticed. WE is clinically often composed of a triad including nystagmus, ophthalmoplegia and altered mental status. Although this triad practically is present only in a handful of cases1 it is also described as an acute neuropsychiatric presentation of thiamine deficiency. Early diagnosis and prompt treatment are of utmost importance here as it can prevent chronic brain damage which is often the end effect of thiamine deficiency. Wernicke’s encephalopathy is most commonly found in patients with chronic alcoholism, less frequent in non-alcoholic patients. In non-alcoholic patients, Wernicke’s encephalopathy might develop due to erosion of upper portion of gastrointestinal tract or secondary to intractable vomiting, inadequate dietary intake or malabsorption. Other causes include malignancies (gastric cancer, leukaemia, lymphoma), hyperemesis, anorexia, thyroid conditions.1,2 Wernicke’s encephalopathy is caused due to thiamine (B1) deficiency. B1 is a water-soluble vitamin which acts as a co-factor for carbohydrate metabolism. It is also important for neuronal cell function.2 This vitamin can’t be synthesised in the human body and thus dietary intake play a very important role. Symptoms of thiamine deficiency Include - Nystagmus, ataxia, encephalopathy, mental confusion. Early onset includes symptoms like: - headache, irritability, fatigue and abdominal discomfort. Prophylactic thiamine supplementation forms a major treatment for patients at risk for developing refeeding syndrome (RFS). RFS is an underdiagnosed condition which is characterised by potential shift in the fluid and electrolytes.

scholarly journals Machiafava-Bigmami and Wernicke’s Encephalopathy: Association of two rare conditions

2021 ◽  
Author(s):  
Dan Mohamed Salman ◽  
Raphael Palomo Barreira ◽  
Marcelo Tognato Ximenes ◽  
Lucas Ghisleri ◽  
Vivian Gagliardi ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
Cerebellar Atrophy ◽  
Altered Mental Status ◽  
Chronic Alcoholism ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Mammillary Bodies ◽  
Eye Opening ◽  
The Right ◽  
Record Review

Introduction: Both Machiafava-Bigmami disease (MBD) and Wernicke’s encephalopathy (WE) result from hypovitaminosis mainly associated with chronic alcoholism. The former affects the corpus callosum while the latter affects mostly the mammillary bodies. There are two main clinical subtypes for MBD in Heinrich’s classification. In type A the entire corpus callosum is affected and is characterized by acute or subacute lowering of consciousness and pyramidal deficits. A poor outcome is expected even with initial, prompt therapy. Methods: Case study with medical record review. Case report: Female patient, 53 years old, with subacute monoparesis in the right lower limb, progressing to generalized paresis, altered mental status and communication impairment. She reported smoking and chronic alcohol addiction for 30 years. She was emaciated, dehydrated, drowsy, sometimes agitated; she had eye opening to speech, dysarthric, bradypsychic, hypoactive pupils, bilateral evoked horizontal nystagmus, proximal paresis with dystonic posture. Impaired coordination and gait, with no other positive findings. Head-CT showed hypodensity in the corpus callosum, more pronounced in the splenium. Head- MRI indicated signs of abnormal impregnation in the mammillary bodies, cerebellar atrophy in the anterior vermis, diffuse cytotoxic lesion in the corpus callosum compatible with toxic demyelination. Conclusion: Although rare, such conditions must be recognized and treated promptly in order to delay progress and improve prognosis.

scholarly journals MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Gaetana Manzo ◽  
Angela De Gennaro ◽  
Attilio Cozzolino ◽  
Antonietta Serino ◽  
Giacomo Fenza ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Complex Disease ◽  
Hyperemesis Gravidarum ◽  
Vitamin B1 ◽  
Chronic Alcoholism ◽  
Sudden Onset ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Tectal Plate ◽  
Low Prevalence

Wernicke’s encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.

scholarly journals Development of Wernicke’s encephalopathy long after subtotal stomach-preserving pancreatoduodenectomy: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Chikanori Tsutsumi ◽  
Toshiya Abe ◽  
Tomohiko Shinkawa ◽  
Hideyuki Watanabe ◽  
Kazuyoshi Nishihara ◽  
...  
Keyword(s):  
Short Term Memory ◽  
Chronic Alcoholism ◽  
Ampulla Of Vater ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Post Surgery ◽  
Level Of Consciousness ◽  
Fluid Attenuated Inversion Recovery ◽  
After Effect ◽  
Thiamine Level

Abstract Background Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine (vitamin B1) deficiency, frequently associated with chronic alcoholism and total parenteral nutrition without thiamine. However, only a few reports have focused on the relationship between WE and subtotal stomach-preserving pancreatoduodenectomy (SSPPD). Case presentation A 71-year-old woman underwent SSPPD for an adenocarcinoma of the ampulla of Vater. Although there had been no evidence of recurrence, the patient was treated with antibiotics for cholangitis at 12 and 31 months, respectively, post-surgery. Thereafter, the patient presented with vomiting and disorientation 33 months after surgery. Although she was admitted and underwent closer inspection by a neurologist and a psychiatrist, the exact cause of these syndromes remained unknown. The psychiatrist measured thiamine concentration to examine the cause of disorientation. After 6 days, her level of consciousness worsened. Magnetic resonance imaging of the head showed symmetrically multiple abnormal hyperintense signals on fluid-attenuated inversion-recovery and diffusion weighted image, compatible with WE. An administration of intravenous thiamine was immediately initiated. After 8 days of the measurement of the thiamine level, the patient’s serum thiamine level was found to be 6 µg/mL (reference range, 24–66 µg/mL). Accordingly, the patient was diagnosed with WE. Shortly after starting the treatment, blood thiamine value reached above normal range with significant improvement of her confusional state. However, short-term memory and ataxia remained. Conclusions Development of WE after SSPPD is uncommon. However, to prevent an after-effect, the possibility of development of WE after SSPPD should be recognized.

scholarly journals Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 709-713
Author(s):  
Piergiorgio Fedeli ◽  
Richard Justin Davies ◽  
Roberto Cirocchi ◽  
Georgi Popivanov ◽  
Paolo Bruzzone ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Gastrointestinal Surgery ◽  
Vitamin B1 ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Vitamin Intake ◽  
Unbalanced Diet ◽  
Prolonged Hospital ◽  
Care Costs

AbstractCarl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke’s encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke’s encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke’s encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke’s encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.

scholarly journals A case of nonalcoholic Wernicke’s encephalopathy due to an extreme diet based on magnetic resonance imaging features

2019 ◽  
Vol 28 (3) ◽  
pp. 276-9
Author(s):  
Julius July ◽  
Adeline ◽  
Girianto Tjandrawidjaja ◽  
Yusak Mangara Tua Siahaan ◽  
Allen Widysanto ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Vitamin B1 ◽  
Dorsal Surface ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Neck Stiffness ◽  
Fluid Attenuated Inversion Recovery

Wernicke’s encephalopathy is a rare occurrence in Indonesia because alcohol consumption is very low. However, in Indonesia, Wernicke’s encephalopathy could be triggered by an inadequate intake of thiamine (vitamin B1) due to an extreme diet for several months. It is a case of a 31-year-old male, who presented to the emergency room with a decreased level of consciousness. According to the family, for the last few weeks, he has become less responsive and less attentive. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) revealed a unique picture with symmetrical lesions in the bilateral medial thalamus, mammillary bodies, periaqueductal gray matter, and the dorsal surface of the medulla oblongata. Clinically, there is no neck stiffness and no fever. The laboratory results from the blood and cerebrospinal fluid have ruled out meningitis. Treatment with thiamine 200 mg t.i.d. has shown an excellent response and significant clinical improvement. The earlier thiamine substitution treatment is started, the better the outcome because thiamine will prevent further injury to the brain and enhance recovery.

scholarly journals Wernicke Encephalopathy as a Complication of Hyperemesis Gravidarum: Case Report

2020 ◽  
Vol 42 (10) ◽  
pp. 672-675
Author(s):  
Ênio Luis Damaso ◽  
Estella Thaisa Sontag dos Reis ◽  
Felipe Alves de Jesus ◽  
Alessandra Cristina Marcolin ◽  
Ricardo de Carvalho Cavalli ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Clinical Status ◽  
Vitamin B1 ◽  
Anterograde Amnesia ◽  
Pregnant Patient ◽  
Chronic Alcoholism ◽  
Wernicke Encephalopathy ◽  
Rapid Improvement ◽  
Vitamin B1 Deficiency ◽  
Magnetic Resonance Imaging Mri

AbstractWernicke encephalopathy (WE) is an acute neurological disorder resulting from vitamin B1 deficiency, which is common in chronic alcoholism. We report a rare case of WE due to hyperemesis gravidarum in a 25-year-old pregnant patient at 13 weeks and 5 days of gestation. Initially, the disease manifested as weakness, mental confusion, anterograde amnesia, and visual and auditory hallucinations. The diagnosis was established after the detection of suggestive findings of WE in the thalamus by magnetic resonance imaging (MRI) and a rapid improvement in the patient's clinical status subsequent to treatment with thiamine. Hyperemesis is a rare cause of WE, which makes the reported case important in the literature and reinforces the need for attention in clinical practice to rare but important complications of this common condition (hyperemesis gravidarum).

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