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Wernicke Encephalopathy

Tripti Aneja, Latha Chaturvedula, Pradeep Pankajakshan Nair, Deepak Barathi, Anish Keepanasseril
Wernicke's encephalopathy (WE) is an uncommon neurological complication in pregnancies complicated with hyperemesis due to thiamine deficiency. In women with hyperemesis, inadvertent glucose administration prior to thiamine supplementation triggers the development of neurological manifestations. Delay in the diagnosis can lead to maternal morbidity, and in one-third of cases may lead to persistence of some neurological deficit. With early recognition and thiamine supplementation, complete recovery is reported...
February 7, 2019: BMJ Case Reports
Venkata Lakshmi Narasimha, Suhas Ganesh, Sarath Reddy, Lekhansh Shukla, Diptadhi Mukherjee, Arun Kandasamy, Prabhat K Chand, Vivek Benegal, Pratima Murthy
Aim: To define the prevalence and clinical presentation of pellagra, a multi-systemic disease caused by the deficiency of niacin, in patients admitted to a tertiary addiction treatment centre in southern India, with alcohol dependence syndrome (ADS)-(ICD10). Methods: Review of the health records of 2947 patients who received inpatient care for ADS between 2015 and 2017. Results: Out of 2947, 31 (1%) were diagnosed with pellagra. Nearly two-thirds (64...
February 5, 2019: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
Jonatan Salzer, Jan Zizka, Mikael Karlberg
Wernicke encephalopathy is a condition in which thiamine deficiency causes cognitive dysfunction, ataxia and eye motor abnormalities. The condition is potentially reversible if treated with high doses of intravenous thiamine (vitamin B1). The video head impulse test, in which the vestibulo-ocular reflex is tested, can reveal an early specific sign of selective dysfunction in the medial vestibular nuclei by demonstrating selective dysfunction of the horisontal vestibulo-ocular reflex. We present two cases with clinical and neuroradiological findings consistent with Wernicke encephalopathy where such oculomotor findings were detected...
January 24, 2019: Läkartidningen
Matthias Maschke
Delirium is a potentially life-threating acute disease accompanied by a mortality up to 30 % of all affected patients. It occurs more frequently in older patients ≥ 65 years. Delirium is defined as acute onset of disturbances in attention, awareness and cognition that develops within a short period of time and fluctuates in severity. It can be subdivided in hyperactive, hypoactive and a mixed type. The hypoactive type occurs more frequently in geriatric patients and has the highest mortality of all types...
January 2019: Deutsche Medizinische Wochenschrift
İpek Güngör Doğan, Güneş Uzun Altiokka, Fulya Türker, Bülent Saka, Başar Bilgiç, Elif Kocasoy Orhan
Introduction: Wernicke's encephalopathy (WE) is an underdiagnosed neuropsychiatric disorder especially in non-alcoholic groups that causes morbidity-mortality if diagnosis is delayed. Korsakoff syndrome is a chronic consequence of this condition characterized by persistent memory impairment. In this study we present a series of non-alcoholic patients with WE. The purpose of this study was to analyze the predisposing factors in non-alcoholic patients with WE and emphasize the importance of early diagnosis and treatment with thiamine supplementation...
December 2018: Noro Psikiyatri Arsivi
Chukwudumebi Okafor, Manojna Nimmagadda, Sarthak Soin, Lavanya Lanka
Thiamine is an important coenzyme, which is essential for metabolism and maintaining cellular osmotic gradient. Thiamine deficiency can cause focal lactic acidosis, alteration of the blood-brain barrier and the production of free radicals through cell death by necrosis and apoptosis. Wernicke encephalopathy (WE) is a clinical diagnosis. Cytotoxic and vasogenic oedema are the most typical neuroimaging findings of WE, presenting as bilateral symmetrical hyperintense signals on T2-weighted MR images. MRI is not necessary for the diagnosis of WE, but it can be helpful in ruling out alternative diagnosis...
December 27, 2018: BMJ Case Reports
Meir Mouallem, Moran Livne Margolin, Yehudit Eden Friedman, Hadas Blankenfeld
Duodenal Switch procedure is a type of bariatric surgery that was reserved for severely morbid obese people. Patients undergoing this procedure are at high risk for nutrient deficiencies. In this report we present a case of a patient who had developed polyneuropathy, generalized muscle weakness, Wernicke encephalopathy, myocardial dysfunction and pericardial effusion six years following this operation. He was treated by multivitamins and trace elements with a complete resolution of all of these disturbances...
2018: Acta Medica (Hradec Králové)
Kiran Kumar Ramineni, Sravan Kumar Marupaka, Ravikanth Jakkani, Abhijeet Ingle
No abstract text is available yet for this article.
October 2018: Annals of Indian Academy of Neurology
João Paulo de Vasconcelos Leitão, Romélia Pinheiro Gonçalves Lemes, Maritza Cavalcante Barbosa, Beatriz Stela Gomes de Souza Pitombeira Araújo, Karine Sampaio Nunes Barroso, Jacques Kaufman, Talyta Ellen de Jesus Dos Santos, Anna Thawanny Gadelha Moura, André Rodrigues Façanha Barreto, Fernando Barroso Duarte
Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition...
October 2018: Revista da Associação Médica Brasileira
Nadia Hammoud, Joohi Jimenez-Shahed
Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions. Once identified, nutritional supplementation and cessation measures are critical in preventing further neurologic damage. The proposed mechanisms of neuronal injury in chronic alcohol abuse include direct toxic effects of alcohol and indirect effects, including those resulting from hepatic dysfunction, nutritional deficiencies, and neuroinflammation...
February 2019: Clinics in Liver Disease
James D Maloy, Ronny M Otero
Wernicke's encephalopathy is an important condition for the emergency physician (EP) to consider in patients at risk for malnutrition. A 60-year-old man with history of alcoholism presented with word-finding difficulties, dysmetria, ataxia, and personality changes. After treatment with high-dose thiamine, his neurological status returned to his baseline. Although EPs routinely prescribe thiamine for patients with alcoholism, the common initial dose of 100 mg per day is likely subtherapeutic, and the population of patients at risk for malnutrition is much broader than only those with alcoholism, and includes those with cancer, anorexia nervosa, hyperemesis gravidarum, and others...
November 2018: Clinical practice and cases in emergency medicine
Lauren Macleod Linder, Sophie Robert, Kristen Mullinax, Genevieve Hayes
BACKGROUND: Alcohol use disorder (AUD) is the leading cause of thiamine deficiency and can lead to Wernicke's encephalopathy (WE). WE has a higher prevalence of development in patients with AUD, and current recommendations emphasize parenteral administration of thiamine. Our objective was to characterize thiamine utilization in patients with AUD who were prescribed thiamine and evaluate if those who received oral thiamine had risk factors for the development of WE. METHODS: This retrospective chart review enrolled adults admitted to a psychiatric hospital from October 2014 through September 2015 diagnosed with AUD as per the International Classification of Diseases, Ninth Edition (ICD-9)...
September 2018: Journal of Psychiatric Practice
Samar A Abbas, Halim Abboud, Moussa A Chalah, Chadi Sabbagh, Samar S Ayache
We report atypical magnetic resonance imaging (MRI) lesions in a case of Wernicke encephalopathy. The patient presented with isolated anterograde amnesia following a partial colectomy complicated by peritonitis. Fluid-attenuated inversion recovery and T2 MRI sequences were normal. However, bilateral contrast enhancement of mammillary bodies was shown on T1 gadolinium-enhanced sequences. Blood tests revealed thiamine deficiency. The diagnosis of Wernicke encephalopathy was made and thiamine supplementation was given, resulting in complete recovery of the memory functions...
November 12, 2018: Behavioral Sciences
Yasushi Iwasaki, Rina Hashimoto, Yufuko Saito, Ikuko Aiba, Akira Inukai, Akio Akagi, Maya Mimuro, Hiroaki Miyahara, Tetsuyuki Kitamoto, Mari Yoshida
An 83-year-old Japanese man presented with gait disturbance followed by rapidly-progressive cognitive impairment. Magnetic resonance diffusion-weighted images showed extensive hyperintense regions in the cerebral cortex. Four weeks after symptom onset, myoclonus appeared, and the patient developed difficulty swallowing; intravenous peripheral continuous infusions without vitamin supplementation were administered during the last two months of the patient's life. The patient reached the akinetic mutism state and died 12 weeks after symptom onset due to sepsis...
November 8, 2018: Prion
Smit Patel, Karan Topiwala, Lawrence Hudson
Wernicke's encephalopathy (WE) is a neurologic emergency that requires immediate attention to prevent permanent neurological morbidity and mortality. It presents with confusion, ophthalmoplegia and gait ataxia which together comprise its classic triad. Thiamine deficiency related to alcohol abuse remains the primary culprit; non-alcoholic WE, however, can have an atypical clinical presentation and is often missed. Thus, although the diagnosis of WE remains primarily clinical, neuroimaging plays an important role, especially in the diagnosis of non-alcoholic WE...
August 22, 2018: Curēus
Sandhya Devaraj, Sara A Muralles, Chandler E Gill, Edwin Meresh
This case discusses the course of a woman with a history of epilepsy, alcohol use disorder, herpes simplex virus (HSV) encephalitis, and Wernicke encephalopathy (WE) who presented with altered mental status following approximately 48 hours of vomiting. After experiencing a tonic-clonic seizure in the emergency department, she developed a fluent aphasia. Aphasias are ordinarily attributed to structural changes in the brain parenchyma, often from stroke, neoplasm, or infection. When the magnetic resonance imaging of brain failed to show changes that could explain her fluent aphasia, the neurology team consulted psychiatry to workup psychogenic aphasia...
2018: Neuropsychiatric Disease and Treatment
Jorge C Kattah, Ali Saber Tehrani, Sascha du Lac, David E Newman-Toker, David S Zee
OBJECTIVE: To explain (1) why an initial upbeat nystagmus (UBN) converts to a permanent downbeat nystagmus (DBN) in Wernicke encephalopathy (WE) and (2) why convergence and certain vestibular provocative maneuvers may transiently switch UBN to DBN. METHODS: Following a literature review and study of our 2 patients, we develop hypotheses for the unusual patterns of vertical nystagmus in WE. RESULTS: Our overarching hypothesis is that there is a selective vulnerability and a selective recovery from thiamine deficiency of neurons within brainstem gaze-holding networks...
October 23, 2018: Neurology
Abin Chandrakumar, Aseem Bhardwaj, Geert W 't Jong
Wernicke encephalopathy (WE) and Korsakoff psychosis (KP), together termed Wernicke-Korsakoff syndrome (WKS), are distinct yet overlapping neuropsychiatric disorders associated with thiamine deficiency. Thiamine pyrophosphate, the biologically active form of thiamine, is essential for multiple biochemical pathways involved in carbohydrate utilization. Both genetic susceptibilities and acquired deficiencies as a result of alcoholic and non-alcoholic factors are associated with thiamine deficiency or its impaired utilization...
October 2, 2018: Journal of Basic and Clinical Physiology and Pharmacology
Vikash Talib, Shazia Sultana, Ahmed Hamad, Uzair Yaqoob
Wernicke's encephalopathy (WE) is a life-threatening acute or sub-acute neurological emergency characterized by ataxia, confusion, nystagmus, and ophthalmoparesis caused by thiamine deficiency. It was first described in 1881 by Carl Wernicke with alcohol being the most common cause. We present a rare case of a 35-year-old pregnant female who presented to our emergency department with a history of vomiting and loose motions for two weeks. She later developed fever, confusion, slurred speech and blurring of vision...
July 17, 2018: Curēus
Hideki Onishi, Mayumi Ishida, Nozomu Uchida, Daisuke Shintani, Tadaaki Nishikawa, Kosei Hasegawa, Keiichi Fujiwara, Tatsuo Akechi
OBJECTIVE: Although 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. METHOD: From 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...
August 31, 2018: Palliative & Supportive Care
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