Wernicke's Encephalopathy Complicating Schizophrenia

1993 ◽  
Vol 27 (4) ◽  
pp. 638-652 ◽  
Author(s):  
Bruce Spittle ◽  
Josie Parker
Keyword(s):  
Alcohol Abuse ◽  
Psychiatric Disorder ◽  
Mental State ◽  
Thiamine Deficiency ◽  
Psychiatric Patients ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Altered Mental State

Wernicke's encephalopathy producing an altered mental state may occur in malnourished psychiatric patients even in the absence of alcohol abuse. A case is reported of a woman, aged 61 years, with schizophrenia who refused her medication for four months, had the delusion she was dying from a tumour, and withdrew to her bed with a neglect of her nutrition. She was committed to hospital in a mute unresponsive state and after taking some food and fluids for four days lapsed into coma. She responded within three hours to the administration of thiamine. Clinicians need to remain vigilant to the possibility that an altered mental state in malnourished patients may be due to thiamine deficiency rather than to the primary psychiatric disorder. If doubt exists as to the presence of Wernicke's encephalopathy, then parenteral thiamine should be administered.

Wernicke’s encephalopathy in women with hyperemesis gravidarum – Case series and literature review

2021 ◽  
pp. 004947552110143
Author(s):  
Makarand Anil Rane ◽  
Hari Kishan Boorugu ◽  
Usha Ravishankar ◽  
S Tarakeswari ◽  
Hemamalini Vadlamani ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Rare Complication ◽  
Case Series ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Chronic Alcohol Abuse ◽  
Delayed Treatment ◽  
Altered Mental State ◽  
Short And Long Term ◽  
Clinical Triad

Whilst nausea affects around 80% of pregnant women, hyperemesis gravidarum, an extreme form of the same, affects only 0.5% to 3%, but may lead to severe nutritional deficiency. Wernicke’s encephalopathy is an acute neuropsychiatric disorder which occurs due to thiamine deficiency and needs emergency treatment to prevent neurological morbidity and mortality. Wernicke’s encephalopathy is characterised by a clinical triad of oculomotor abnormalities, cerebellar dysfunction and altered mental state. Korsakoff’s psychosis is a chronic condition and consequence of Wernicke’s encephalopathy, resulting from its delayed treatment. Wernicke’s encephalopathy is a well-known complication of chronic alcohol abuse. Not many are aware of its association with hyperemesis gravidarum. Although it is a rare complication, if not diagnosed and treated promptly, it may result in permanent and irreversible neurological sequelae. The objective of our retrospective observational study was to analyse the clinical profile and outcome (short and long term) in a rare yet preventable complication of pregnancy.

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.

scholarly journals Don’t seek, don’t find: The diagnostic challenge of Wernicke’s encephalopathy

2020 ◽  
pp. 000456322093960
Author(s):  
Sara Kohnke ◽  
Claire L Meek
Keyword(s):  
Bariatric Surgery ◽  
Thiamine Deficiency ◽  
Early Recognition ◽  
Gastrointestinal Surgery ◽  
High Risk Patient ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Cognitive State ◽  
Permanent Disability ◽  
Patient Groups

Wernicke’s encephalopathy is caused by thiamine deficiency and has a range of presenting features, including gait disturbance, altered cognitive state, nystagmus and other eye movement disorders. In the past, Wernicke’s encephalopathy was described almost exclusively in the alcohol-dependent population. However, in current times, Wernicke’s encephalopathy is also well recognized in many other patient groups, including patients following bariatric surgery, gastrointestinal surgery, cancer and pancreatitis. Early recognition of Wernicke’s encephalopathy is vital, as prompt treatment can restore cognitive or ocular function and can prevent permanent disability. Unfortunately, Wernicke’s encephalopathy is often undiagnosed – presumably because it is relatively uncommon and has a variable clinical presentation. Clinical biochemists have a unique role in advising clinicians about potential nutritional or metabolic causes of unexplained neurological symptoms and to prompt consideration of thiamine deficiency as a potential cause in high-risk patient groups. The aim of this review is to summarize the clinical features, diagnosis and treatment of Wernicke’s encephalopathy and to highlight some non-traditional causes, such as after bariatric surgery.

Brain Injury Associated With Chronic Alcoholism

CNS Spectrums ◽  
1999 ◽  
Vol 4 (1) ◽  
pp. 66-68,81-87 ◽  
Author(s):  
Paul W. Ragan ◽  
Charles K. Singleton ◽  
Peter R. Martin
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brain Injury ◽  
Alcohol Abuse ◽  
Brain Damage ◽  
Thiamine Deficiency ◽  
Chronic Alcoholism ◽  
Cerebellar Degeneration ◽  
Wernicke's Encephalopathy ◽  
The Central Nervous System

AbstractAlcoholism can result in a number of severe consequences to the central nervous system, including Korsakoff's psychosis, delusions, delirium, Wernicke's encephalopathy, and cerebellar degeneration. Many of these disorders have a substantially higher prevalence than had been previously believed. Neuropathologic and neuroimaging studies have been instrumental in identifying the changes undergone by the alcoholic brain and the factors that may contribute to alcohol-induced brain damage. Biologic differences appear to make women especially susceptible to central nervous system insult from alcohol abuse. The damage caused by alcohol may be associated, in part, with thiamine deficiency, neuronal excitotoxicity, and magnesium wasting.

scholarly journals Wernicke’s encephalopathy induced by the use of diet pills and unbalanced diet

2014 ◽  
Vol 155 (12) ◽  
pp. 469-474
Author(s):  
Adrián Tóth ◽  
Gabriella Aradi ◽  
György Várallyay ◽  
Zsuzsanna Arányi ◽  
Dániel Bereczki ◽  
...  
Keyword(s):  
Thiamine Deficiency ◽  
Developed Countries ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Chronic Form ◽  
Neurological Signs ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Unbalanced Diet ◽  
Diet Pills

Wernicke’s encephalopathy is an acute, potentially life-threatening, neurological syndrome resulting from thiamine deficiency. The disorder is still greatly underdiagnosed and, without prompt treatment, the condition can lead to the chronic form of the disease, Korsakoff’s syndrome or even death. In developed countries Wernicke’s encephalopathy has been associated with alcoholism, but in recent years there has been an increasing number of non-alcoholic cases. Authors report the case of a 23-year-old woman who developed oculomotor dysfunction, encephalopathy and ataxia as a result of an extreme diet and use of diet pills. The diagnosis of Wernicke’s encephalopathy was supported by the resolution of neurological signs after parenteral thiamine replacement. This case is presented because of the rare etiology and diagnostic difficulty, and the latest diagnostic and therapic guidelines are also highlighted. Orv. Hetil., 2014, 155(12), 469–474.

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.

Severe thiamine deficiency resulted in Wernicke's encephalopathy in a chronic dialysis patient

2006 ◽  
Vol 10 (4) ◽  
pp. 290-293 ◽  
Author(s):  
Kae Ueda ◽  
Daisuke Takada ◽  
Akiko Mii ◽  
Yuko Tsuzuku ◽  
Sabine Kyoko Saito ◽  
...  
Keyword(s):  
Thiamine Deficiency ◽  
Dialysis Patient ◽  
Chronic Dialysis ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Chronic Dialysis Patient

scholarly journals Wernicke's Encephalopathy in a Patient with Peptic Ulcer Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Akinori Uruha ◽  
Toshio Shimizu ◽  
Tomoji Katoh ◽  
Yasushi Yamasaki ◽  
Shiro Matsubara
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Thiamine Deficiency ◽  
Gastrointestinal Surgery ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Upper Gastrointestinal Endoscopy ◽  
Ulcer Disease ◽  
Recurrent Vomiting ◽  
History Of

We report a 74-year-old man with Wernicke's encephalopathy (WE) whose only prior illness was peptic ulcer disease. Upper gastrointestinal endoscopy demonstrated gastric ulcer scars accompanied by marked deformity, without pathologic evidence of malignancy. WE due to peptic ulcer disease in previous reports was substantially associated with thiamine deficiency due to recurrent vomiting or surgical procedures. In our case, however, there was no history of vomiting or gastrointestinal surgery. Besides, we thoroughly ruled out other known clinical settings related to WE. There is the possibility that peptic ulcer disease itself provoked thiamine deficiency due to malabsorption.

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