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  

Wernicke’s encephalopathy post hyperemesis gravidarum misdiagnosed as Guillain-Barre syndrome: lessons for the frontline

2021 ◽  
Vol 14 (3) ◽  
pp. e239977
Author(s):  
Kaushiki Kirty ◽  
Yashendu Sarda ◽  
Annu Jacob ◽  
Delanthabettu Venugopala
Keyword(s):  
Pregnant Woman ◽  
Hyperemesis Gravidarum ◽  
Early Recognition ◽  
Wernicke’S Encephalopathy ◽  
Guillain Barre Syndrome ◽  
Neurological Deficits ◽  
Wernicke's Encephalopathy ◽  
Motor Neuropathy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

We report a case of a 26-year-old pregnant woman, who presented with subacute limb weakness. This was initially suspected to be Guillain-Barre syndrome but subsequently found to be the motor neuropathy of dry beriberi (vitamin B1, thiamine deficiency) along with associated Wernicke’s encephalopathy (WE). The underlying cause was revealed as hyperemesis gravidarum (HG). HG complicates up to 3% of pregnancies and if severe, without nutritional supplements, may lead to electrolyte disturbances, calorie loss and vitamin deficiency. Although the association of HG and WE was first reported in 1939, it remains an under diagnosed condition with potential for serious and permanent neurological deficits, and some mortality, in both mother and baby. Early recognition of the problem, with timely and careful fluid, electrolyte, glucose and vitamin replacement is needed to avoid complications. We highlight current best practice in the treatment of WE. An open mind to the possibility of HG complications in any pregnant woman presenting with neurological symptoms is probably the most important lesson to learn from the front line.

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 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.

scholarly journals Sudden ‘Stroke-Like’ Onset of Hemiparesis Due to Herpetic Encephalitis

1995 ◽  
Vol 22 (4) ◽  
pp. 320-321 ◽  
Author(s):  
Mohammad AbdulJabbar ◽  
Ibrahim Ghozi ◽  
Anwar Haq ◽  
Hanz Korner
Keyword(s):  
Herpes Simplex ◽  
Young Patients ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Type I ◽  
Focal Neurological Deficit ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Herpetic Encephalitis ◽  
Magnetic Resonance Imaging Mri

AbstractBackground/ObjectiveHerpes simplex encephalitis usually has a progressive cause. Sudden neurological deficits are unusual.MethodCase study.ResultsA 17-year-old girl presented with an acute onset focal neurological deficit followed one week later by the more classical feature of altered level of consciousness, fever and focal seizures. The diagnosis of hepetic encephalitis was made by magnetic resonance imaging (MRI) and by the significant increase in cerebrospinal fluid titres of antibodies against herpes simplex type I.ConclusionHerpetic encephalitis should be considered in the differential diagnosis of acute stroke in young patients even in the absence of encephalitic features, if common etiological factors such as embolization and intracerebral bleed are excluded.

Wernicke-Korsakoff syndrome with psychotic symptoms in a severe case of anorexia nervosa: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S346-S346 ◽  
Author(s):  
D. Brigadeiro ◽  
C. Ferreira ◽  
J. Magalhães ◽  
J. Nunes ◽  
P. Santos ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Memory Impairment ◽  
Severe Case ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Psychotic Symptoms ◽  
Confusional State ◽  
Korsakoff’S Syndrome ◽  
Korsakoff Syndrome ◽  
Korsakoff's Syndrome

IntroductionThe Wernicke-Korsakoff syndrome comprises a complex of symptoms including Wernicke's encephalopathy and the Korsakoff's syndrome. While the former is characterized by a classic clinical triad of ataxia, ophtalmoplegia and a global confusional state; the Korsakoff's syndrome is characterized by memory impairment and confabulation. These two entities are now considered as a clinical spectrum of a same disease caused by deficiency of thiamine (vitamin B1).ObjectiveTo describe a case of Wernicke-Korsakoff Syndrome with psychotic symptoms in a 13-year-old female patient with anorexia nervosa.MethodThe patient and family were interviewed. Literature relevant to the case was reviewed.ResultsA 13-year-old Caucasian female was admitted to the emergency department with bradycardia (38 bpm) and a two-month history of weight loss totaling 6 kg. This loss of weight was a result of dietary restriction and over-exercise because she “felt too fat”. On admission she has a body mass index of 12.17. She was diagnosed with anorexia nervosa and was hospitalized. On day 11 after hospitalization, patient initiated alteration in behavior, fluctuating mental state with periods of lucidity and periods of confusion, memory impairment and psychotic symptoms, with paranoid delusions and auditory hallucinations. The classic triad of Wernicke's encephalopathy was not present. The treatment with thiamine was initiated and the symptoms including psychotic symptoms improved.ConclusionWernicke-Korsakoff syndrome should be considered in cases of anorexia nervosa with a confusional state and memory impairment even if the classic symptoms are not present.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Esiste impregnazione contrastografica nell'encefalopatia di Wernicke in fase acuta? Descrizione di 3 casi e revisione della letteratura

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 52-53 ◽  
Author(s):  
C. Tessa ◽  
P. Simonelli ◽  
M. Mascalchi ◽  
F. Giangaspero ◽  
L. Bosincu ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Contrast Enhancement ◽  
Imaging Study ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Proton Density ◽  
Acute Confusional State ◽  
Initial Examination ◽  
Intravenous Contrast ◽  
Mammillary Bodies

MR imaging enabled diagnosis of Wernicke's encephalopathy by showing symmetric areas of increased signal intensity on proton density and T2 weighted images in the periaqueductal gray matter, mammillary bodies, medial thalami and pericentral and interhemispheric cerebral cortex in three non-alcoholic patients who were examined within 3 days of admission for acute confusional state associated with ophthalmoparesis and ataxia. In two patients the initial examination was completed with intravenous contrast administration and no lesion enhancement was seen. In the third patient computed tomography 10 days after the initial MR imaging study showed marked contrast enhancement of the lesions. Our data and a review of the literature indicate that lesion contrast enhancement presumably reflecting disruption of the blood brain barrier may be lacking in the early phases of Wernicke's encephalopathy. Acquisition and careful evaluation of long TR images is crucial to the diagnosis of Wernickes encephalopathy with MR imaging in the acute phase.

Wernicke’s Encephalopathy: An Underrecognized and Reversible Cause of Confusional State in Cancer Patients

Oncology ◽  
2008 ◽  
Vol 76 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Sheng-Han Kuo ◽  
J. Mathew Debnam ◽  
Gregory N. Fuller ◽  
John de Groot
Keyword(s):  
Cancer Patients ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Confusional State

scholarly journals Coma and death in unrecognized wernicke's encephalopathy an autopsy study: estudo necroscópico

1992 ◽  
Vol 50 (3) ◽  
pp. 329-333 ◽  
Author(s):  
Marco Aurélio Lana-peixoto ◽  
Eustáquio Claret Dos Santos ◽  
José Eymard H. Pittella
Keyword(s):  
Hyperemesis Gravidarum ◽  
Third Ventricle ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Severe Malnutrition ◽  
Unknown Etiology ◽  
Autopsy Study ◽  
Mammillary Bodies ◽  
Superior Part ◽  
Central Pontine

Eleven out of 36 autopsied cases of Wernicke's encephalopathy had developed coma. None of these patients had the diagnosis during life. There were six men and five women with ages ranging from 36 to 50 years (mean 36.6). Seven of these patients were heavy drinkers, three exhibited signs of severe malnutrition, whereas one was being evaluated for a disseminated gastric cancer and one was in treatment of hyperemesis gravidarum. Two patients were brought to the hospital after found unconscious at home. Neuropatholo-gical examination disclosed gross changes in the mammillary bodies in eight cases and microscopic changes in all cases. In one case there was atrophy of the anterior superior part of the vermis. Petechial hemorrhages were observed particularly in the walls of the third ventricle. Microscopically there were in addition to hemorrhages, glial proliferation, endothelial hypertrophy and necrosis of nerve cells and myelin. Central pontine myelmolysis was observed in one case. Wernicke's encephalopathy is a clinically underdiagnosed condition. Coma may mask its classical clinical picture or even be the sole manifestation. Although coma points to a poor outlook it may be reversed by thiamine administration. Any patient with Coma of unknown etiology should be given parenteral thiamine.

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