scholarly journals Bithalamic Dysfunction in Wernicke’s Encephalopathy

2017 ◽  
Vol 31 (1&2) ◽  
pp. 23 ◽  
Author(s):  
Hiroki Nariai ◽  
Eric Mittelmann ◽  
Constantine Farmakidis ◽  
Richard L. Zampolin ◽  
Matthew S. Robbins
Keyword(s):  
Risk Factors ◽  
Clinical Features ◽  
Brain Mri ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Vascular Risk ◽  
Mammillary Bodies ◽  
Acute Infarction ◽  
Signal Change ◽  
Thiamine Therapy

We describe a 65-year-old, nonalcoholic, right-handed female with multiple vascular risk factors who developed transient visuospatial hemineglect and global aphasia after presenting with the classic triad of Wernicke’s encephalopathy (mental status changes, nystagmus/ophthalmoplegia, and ataxia). A brain MRI showed no evidence of acute infarction, but demonstrated signal change in the medial thalami and mammillary bodies. Intravenous thiamine therapy was given, and visuospatial hemineglect and ophthalmoplegia disappeared while the aphasia improved. The occurrence of these acute transient clinical features has not been previously reported in Wernicke’s encephalopathy. 

scholarly journals Acute Ischemic Stroke in Pregnancy

2019 ◽  
Vol 11 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Rita Rodrigues ◽  
Renata Silva ◽  
Luís Fontão ◽  
Luís Ruano ◽  
José Mário Roriz
Keyword(s):  
Risk Factors ◽  
Brain Mri ◽  
Sudden Onset ◽  
Transthoracic Echocardiogram ◽  
Vascular Risk ◽  
Ecg Monitoring ◽  
Past Medical History ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Angio Ct

Stroke is an uncommon but serious potential complication of pregnancy. The management of acute ischemic stroke in pregnant women remains a complex challenge that extends beyond the limits of clinical trial evidence. Patient 1 was a 29-year-old woman 27 weeks into her first pregnancy, without remarkable past medical history or vascular risk factors. She was admitted 1 h after sudden onset of a left total anterior circulation syndrome (National Institute of Health Stroke Scale [NIHSS] score of 23). CT and angio-CT scans were normal. Thrombolysis was performed, with mild clinical improvement. Brain MRI showed multi-territorial embolic events. Extended blood panel, cervical-transcranial ultrasound, 48-h ECG monitoring, and transthoracic echocardiogram were unremarkable. She was started on aspirin and low-molecular-weight heparin (LMWH), giving birth to a healthy child 10 weeks later. Patient 2 was a 45-year-old woman 34 weeks into her pregnancy, without remarkable past medical history or vascular risk factors. She was admitted 30 min after sudden onset of a left partial anterior circulation syndrome, already partially recovered (NIHSS score of 4). The CT scan showed only a subacute right incidental middle cerebral artery infarct, while the angio-CT confirmed a left M3 branch occlusion. Thrombolysis and thrombectomy were contraindicated by the recent contralateral infarct, mild deficits, and distal occlusion site. Brain MRI also suggested an embolic etiology and LMWH was started. Extended blood panel, 48-h ECG monitoring, and transthoracic echocardiogram were normal. She gave birth to a healthy baby 4 weeks later. These cases emphasize the growing real-world evidence of the emergent use of CT, IV contrast, and recombinant tissue plasminogen activator in pregnant women with acute stroke, while also illustrating the importance of an individualized management, accounting for the safety of both mother and child.

Wernicke’s encephalopathy-induced hearing loss complicating sleeve gastrectomy

2020 ◽  
Vol 13 (9) ◽  
pp. e233144
Author(s):  
Elaf Abdulnabi Mohammed ◽  
Sulaiman Ali Hajji ◽  
Khaled Aljenaee ◽  
Mohammad Ibrahim Ghanbar
Keyword(s):  
Hearing Loss ◽  
Sleeve Gastrectomy ◽  
Magnetic Resonance ◽  
Brain Mri ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Signal ◽  
Inversion Recovery Imaging ◽  
Successful Recovery ◽  
The Brain

A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke’s encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67–200).

Wernicke’s encephalopathy confirmed via brain MRI in cancer patient

2012 ◽  
Vol 46 (1) ◽  
pp. 70-71 ◽  
Author(s):  
Sang Min Lee ◽  
Won Sub Kang ◽  
Ah Rang Cho ◽  
Jin Kyung Park
Keyword(s):  
Cancer Patient ◽  
Brain Mri ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy

Prevalence of hippocampal enlarged perivascular spaces in a sample of patients with hypertension and their relation with vascular risk factors and cognitive function

2018 ◽  
Vol 89 (6) ◽  
pp. 651-656 ◽  
Author(s):  
Joan Jiménez-Balado ◽  
Iolanda Riba-Llena ◽  
Edurne Garde ◽  
Marta Valor ◽  
Belen Gutiérrez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Function ◽  
Rating Scale ◽  
Brain Mri ◽  
Treatment Compliance ◽  
Vascular Risk Factors ◽  
Study Cohort ◽  
Perivascular Spaces ◽  
Vascular Risk ◽  
Verbal Reasoning

ObjectivesThe clinical importance of hippocampal enlarged perivascular spaces (H-EPVS) remains uncertain. We aimed to study their association with vascular risk factors, cognitive function and mild cognitive impairment (MCI).MethodsData were obtained from the ISSYS (Investigating Silent Strokes in hYpertensives, a magnetic resonance imaging Study) cohort, which is a prospective study of patients with hypertension aged 50–70 with no prior stroke or dementia. Participants were clinically evaluated and underwent a cognitive screening test, Dementia Rating Scale-2, which includes five cognitive subscales (attention, initiation/perseveration, conceptualisation, construction and memory). Besides, they were diagnosed with MCI or normal ageing following standard criteria. H-EPVS were manually counted on brain MRI according to a previous scale and defined as extensive when H-EPVS count was ≥7 (upper quartile). Multivariate models were created to study the relationship between H-EPVS, vascular risk factors and cognitive function.Results723 patients were included; the median age was 64 (59–67) and 51% were male. Seventy-two patients (10%) were diagnosed with MCI and 612 (84.6%) had at least 1 H-EPVS. Older age (OR per year=1.04, 95% CI 1.01 to 1.08) and poor blood pressure treatment compliance (OR=1.50, 95% CI 1.07 to 2.11) were independently associated with extensive H-EPVS. Regarding cognitive function, H-EPVS were independently and inversely correlated with verbal reasoning (β=−0.021, 95% CI −0.038 to −0.003). No association was found between H-EPVS and MCI.ConclusionsH-EPVS are a frequent finding in patients with hypertension and are associated with ageing and poor hypertension treatment compliance. Besides, H-EPVS are associated with worse verbal reasoning function.

scholarly journals Wernicke’s encephalopathy- a case report

2018 ◽  
Vol 1 (1) ◽  
pp. 78-81
Author(s):  
Baikuntha Raj Adhikari ◽  
N Sapkota ◽  
R Gautam ◽  
M Basnet ◽  
P Koirala ◽  
...  
Keyword(s):  
Alcohol Intake ◽  
Acute Onset ◽  
Wernicke’S Encephalopathy ◽  
Neurological Deficits ◽  
Wernicke's Encephalopathy ◽  
Confusional State ◽  
Mammillary Bodies ◽  
Persistent Memory ◽  
Magnetic Resonance Imaging Mri ◽  
Oculomotor Abnormalities

Wernicke's encephalopathy is a neuropsychiatric disorder characterized by acute onset, nystagmus and oculomotor abnormalities, and a confusional state. Chronic alcohol intake is still the most common reason. Wernicke's encephalopathy, if not recognized and treated, can become irreversible. Common findings in Magnetic Resonance Imaging (MRI) include: symmetric T2 Weighted Image (T2) hyperintensities in peri-aqueductal gray matter, dorsal medial thalamus and mammillary bodies. This case highlights neurological deficits, persistent memory and disorientation.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, page: 78-81  

scholarly journals Case of non-alcoholic Wernicke’s encephalopathy

2019 ◽  
Vol 12 (11) ◽  
pp. e230763
Author(s):  
Mark D Theodoreson ◽  
Ausrine Zykaite ◽  
Michael Haley ◽  
Saroj Meena
Keyword(s):  
Grey Matter ◽  
Wernicke’S Encephalopathy ◽  
Medical Emergency ◽  
Wernicke's Encephalopathy ◽  
High Signal ◽  
Alcoholic Patient ◽  
Mammillary Bodies ◽  
Unsteady Gait ◽  
History Of ◽  
Vertical Gaze

A 61-year-old obese man presented with 8-week history of nausea and occasional vomiting. He reported poor appetite and unintentional weight loss of more than 20 kg of his body mass. A week after admission, he developed double vision and unsteady gait. Neurological examination revealed isolated sixth cranial nerve palsy on the left side with horizontal nystagmus that progressed to bilateral lateral gaze palsy with normal vertical gaze. Brain MR revealed T2/fluid attenuation inversion recovery (FLAIR) high signal in mammillary bodies, tectum of the midbrain and the periaqueductal grey matter. He was diagnosed with Wernicke’s encephalopathy (WE). WE is a medical emergency that carries high mortality yet can be often under-diagnosed in the non-alcoholic patient. Varied presentation and absence of alcohol dependence lowers the degree of suspicion and this was true in this case. The patient was given intravenous thiamine and made a rapid and dramatic recovery.

scholarly journals Wernicke’s Encephalopathy: An Unusual Consequence of the Acquired Immune Deficiency Syndrome—Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Timothy R. Larsen ◽  
Dritan Dragu ◽  
Michael Williams
Keyword(s):  
Immune Deficiency ◽  
Brain Mri ◽  
Immune Deficiency Syndrome ◽  
Acquired Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Classic Triad ◽  
Relative Safety ◽  
Acquired Immune Deficiency

Introduction.Wernicke’s encephalopathy is a well-described syndrome characterized by the classic triad of confusion, ataxia, and ophthalmoplegia. Wernicke’s encephalopathy results from thiamine (vitamin B1) deficiency. Common causes include alcoholism and gastric disorders. Wernicke’s has been described in patients with acquired immune deficiency syndrome (AIDS); however, given these patients’ immunosuppressed state, the diagnosis of Wernicke’s encephalopathy is not apparent.Case Presentation.A 31-year-old previously healthy male presented to the ER complaining of progressive dyspnea. Workup revealed HIV/AIDS and PCP pneumonia. He was treated and improved. On day 14 he became confused and developed nystagmus and ataxia. Considering his immunocompromised state, infectious and neoplastic etiologies topped the differential diagnosis. CT head was negative. Lumbar puncture was unremarkable. Brain MRI revealed increased T2 signal in the medial thalamus bilaterally. Intravenous thiamine was administered resulting in resolution of symptoms.Discussion.The classic triad of Wernicke’s encephalopathy occurs in 10% of cases. When immunosuppressed patients develop acute neurologic symptoms infectious or neoplastic etiologies must be excluded. However, given the relative safety of thiamine supplementation, there should be a low threshold for initiating therapy in order to reverse the symptoms and prevent progression to Korsakoff dementia, which is permanent.

scholarly journals Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient

2021 ◽  
Vol 23 (2) ◽  
pp. 76-83
Author(s):  
R. O. Kantariya ◽  
O. N. Vetchinnikova ◽  
A. V. Vatazin ◽  
L. A. Sherman
Keyword(s):  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Brain Mri ◽  
Plasma Concentrations ◽  
Graft Function ◽  
Calcineurin Inhibitors ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Good Effect ◽  
Magnetic Resonance Imaging Mri

Background. Non-alcoholic Wernicke’s encephalopathy occurs in various somatic conditions with thiamine deficiency, excessive excretion of thiamine, or impaired thiamine metabolism. Very few cases of this pathology have been described in chronic kidney disease (CKD). We present a unique case of non-alcoholic Wernicke’s encephalopathy in a patient with a kidney transplant is presented.Past medical history. The patient underwent kidney transplantation in 2008. Outpatient follow-up by a nephrologist was irregular. Renal graft function remained relatively stable: blood creatinine 200–240 μmol/L, estimated glomerular filtration rate 40–30 mL/min, tacrolimus plasma concentrations tended to increase (5.7–7.6–8.4–10.4 ng/mL); repeated graft biopsy (in 2015 and in 2017) determined the chronic toxicity of calcineurin inhibitors. The patient’s condition worsened in late January 2020: body temperature increased to 38°C, nausea, vomiting, loose, watery stools for up to 5 times per day, 8 kg weight loss, decreased diuresis. A few days later, double vision, shaky gait and then immobility appeared. Biochemical examination results: potassium 3.8 mmol/L, sodium 139 mmol/L, alpha-amylase 159 units/L (norm 0–100 units/L), creatinine 242 mmol/L, urea 13.2 mmol/L; ultrasound signs of pancreatitis. Magnetic resonance imaging (MRI) of the brain: bilateral diffuse lesions of the midbrain, thalamus, and cerebellum. Based on the clinical picture and on brain MRI results, Wernicke’s encephalopathy was diagnosed. Parenteral administration of thiamine had a good effect.Conclusion. Possible mechanisms of the development of Wernicke’s encephalopathy in a patient were discussed. Vigilance is required regarding this disease when metabolic disorders occur in patients with CKD.

Sign in / Sign up

Export Citation Format

Share Document