Thiamine-Responsive Acute Neurological Disorders in Nonalcoholic Patients

Abstract

Wernicke’s encephalopathy (WE) is most commonly associated with alcoholism, although other causes have also been implicated. In the years 1994–1997, 9 patients with no history of alcohol abuse presented with acute signs of ophthalmoplegia or nystagmus and ataxia which resolved within 48 h after intravenous thiamine. There were 7 women and 2 men aged 17–57 (7 below the age of 30). Precipitating events included vomiting 2, drastic weight-reducing diet 2, renal colic in a postpartum woman 1, colonic surgery 2 and chronic hemodialysis 1. In 2 patients there was no obvious precipitating event but their history was suggestive of a genetic predisposition. Mental changes were slight or absent in all patients and all of them made good functional recovery. These cases suggest that the diagnosis of WE should be considered more often in nonalcoholics in various clinical settings.

Wernicke's encephalopathy due to hyperemesis gravidarum

“…Recent case studies reveal vulnerability in patients with thiamine deficiency secondary to anorexia nervosa or other psychiatric conditions, prolonged intravenous feeding without proper supplementation, gastrointestinal surgery (especially bariatric surgery), and systemic malignancy. [34] Thiamine is a cofactor for several key enzymes important in energy metabolism, including transketolase, alpha-ketoglutarate dehydrogenase, and pyruvate dehydrogenase. Thiamine requirements depend on metabolic rate, with the greatest need during periods of high metabolic demand and high glucose intake (including glucose-containing intravenous fluids).…”

Wernicke's encephalopathy in a patient with gastric carcinoma: a diagnosis not to miss

“…Increased thiamine consumption due to the rapid growth of cancer cells and inadequate nutrition due to nausea and anorexia from chemotherapy or malabsorption syndrome have been suggested as possible reasons for cancer-associated WE 6 7…”

Thiamine and Parkinson's disease

“…These findings suggested that thiamine might have a role in dopaminergic neuron activity. Interestingly, parental thiamine administration was used successfully in 9 non-alcoholic patients who presented with acute neurological disorders [108]. Administration of the combination of thiamine and acetazolamide was reported to reduce scores on the Abnormal Involuntary Movement Scale (AIMS) and the Simpson-Angus Neurological Rating Scale (ANRS) in patients with the tardive dyskinesia and parkinsonism symptoms [109].…”