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 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.

scholarly journals Co-occuring Toxoplasma Infection and Psychotic Symptoms : Case Report

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Carla R Marchira ◽  
Andrian F Kusumadewi ◽  
Patricia Wulandari
Keyword(s):  
Life Support ◽  
The United States ◽  
The Body ◽  
Psychotic Symptoms ◽  
Toxoplasma Infection ◽  
Case Presentation ◽  
The Family ◽  
Brain Neurotransmitter ◽  
The Brain

Abstract   Introduction Schizophrenia is a neuropsychiatric disease that is global and is experienced by 1% of the population in the United States and Europe. This study raises awareness of the role of infectious agents in the initiation of psychotic symptoms in schizophrenia. Case Presentation A 20-year-old man is taken by the family to the emergency department because he has decreased consciousness, and the body suddenly stiffens. Patients begin to experience changes in behavior in the form of difficulty sleeping, when invited to talk quietly, laughing alone and whispering without the other person. TORCH examination found an increase in anti-toxoplasma IgM and IgG. This patient is then given basic life support in the form of ABC (airway, breathing, circulation support) and seizure management. Also given risperidone 2 mg / 12 hours, pyrimethamine 1-II (1x200 mg), pyrimethamine day III-XXI (1x 25 mg), intravenous Cefotaxim 2g / 8 hours, Clindamycin 500 mg / 8 hours. The patient experienced improvement after the second week of treatment. Conclusion Toxoplasmosis causes lesions in the brain that cause changes in brain neurotransmitter pathways, which lead to changes in patient behavior.

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.

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.

scholarly journals Subclinical thiamine deficiency identified by pretreatment evaluation in an esophageal cancer patient

2020 ◽  
Author(s):  
Akira Yoshioka ◽  
Izumi Sato ◽  
Hideki Onishi ◽  
Mayumi Ishida
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Thiamine Deficiency ◽  
Treatment Plan ◽  
The Body ◽  
Nutritional Evaluation ◽  
Ocular Symptoms ◽  
Marked Decline ◽  
Thiamine Level

Abstract Despite the fact that both thiamine deficiency (TD) and Wernicke encephalopathy (WE) have been observed to some degree in cancer patients, such cases of TD and/or WE reported to date have all been diagnosed after the initiation of treatment. We here report a case of TD that presented without the commonly accepted triad of WE symptoms based on a total nutritional evaluation prior to the onset of treatment for cancer. The patient was a 71-year-old man with esophageal cancer who was referred to the oncology outpatient clinic for evaluation to determine the treatment plan. Although he did not present with delirium, cerebellar signs, or ocular symptoms, TD was suspected based on a reduction in appetite lasting 2 months as thiamine stores in the body are depleted in as few as 18 days. Blood findings showed a marked decline in serum thiamine level supported, which the diagnosis of TD. This case revealed the existence of a cancer patient with subclinical TD prior to the onset of treatment for cancer. Due to the fact that TD can occur without the characteristic symptoms as in this case, we believe it is important that total nutritional evaluation of cancer patients always be considered.

Subclinical thiamine deficiency identified by preoperative evaluation in an ovarian cancer patient: Diagnosis and the need for preoperative thiamine measurement

2018 ◽  
Vol 17 (5) ◽  
pp. 609-610 ◽  
Author(s):  
Hideki Onishi ◽  
Mayumi Ishida ◽  
Nozomu Uchida ◽  
Daisuke Shintani ◽  
Tadaaki Nishikawa ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Thiamine Deficiency ◽  
Clinical Symptoms ◽  
Preoperative Evaluation ◽  
The Body ◽  
Psychiatric Evaluation ◽  
Eye Symptoms ◽  
Her 2 ◽  
Loss Of Appetite

AbstractObjectiveAlthough thiamine deficiency (TD) and Wernicke encephalopathy (WE) are not rare in cancer patients, the cases reported to date developed TD and/or WE after treatment had started.MethodFrom a series of cancer patients, we report a patient diagnosed with TD without the typical clinical symptoms of WE at the preoperative psychiatric examination.ResultA 43-year-old woman with ovarian cancer was referred by her oncologist to the psycho-oncology outpatient clinic for preoperative psychiatric evaluation. Her tumor had been growing rapidly before the referral. Although she did not develop delirium, cerebellar signs, or eye symptoms, we suspected she might have developed TD because of her 2-month loss of appetite as the storage capacity of thiamine in the body is approximately 18 days. The diagnosis of TD was supported by abnormally low serum thiamine levels.Significance of resultsCancer therapists need to be aware that thiamine deficiency may occur even before the start of cancer treatment. In cases with a loss of appetite of more than 2 weeks’ duration, in particular, thiamine deficiency should be considered if the tumor is rapidly increasing, regardless of the presence or absence of delirium.

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

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.

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