Wernicke encephalopathy without delirium in patients with cancer

Onishi, Hideki; Ishida, M.; Tanahashi, Iori; Takahashi, Tsuyoshi; Taji, Yoshitada; Ikebuchi, Kenji; Furuya, Daisuke; Akechi, Tatsuo

doi:10.1017/s1478951517000360

Cited by 17 publications

(28 citation statements)

References 13 publications

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“…In two cases, psychotic symptoms were reportedly severe, despite unaltered consciousness. Usually deliriums with altered states of consciousness are common in WE, although mental status change without altered consciousness has been reported in some cases, and some evidence suggests that a younger age can specifically protect against alterations in consciousness . It is therefore relevant to review a broad range of mental status problems as a possible symptom of WE in AN.…”

Section: Resultsmentioning

confidence: 99%

Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Oudman

Wijnia

Oey

et al. 2018

Psychiatry Clin Neurosci

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Anorexia nervosa (AN) is a common eating disorder that affects 2.9 million people worldwide. Not eating a balanced diet or fasting can cause neurological complications after severe vitamin B1 malnourishment, although the precise signs and symptoms of Wernicke's encephalopathy (WE) are not clear. Our aim was to review the signs and symptoms of WE in patients with AN. We searched MEDLINE, EMBASE, Scopus, and PiCarta on all case descriptions of WE following AN. All case descriptions of WE in AN, irrespective of language, were included. Twelve WE cases were reviewed, suggesting that WE following AN is still a relatively rare neuropsychiatric disorder. WE is characterized by a triad of: mental status change, ocular signs, and ataxia. In alcoholism, this triad is present in 16% of cases, but eight out of 12 AN cases presented themselves with a full triad of symptomatology. Importantly, patients often had a more complex triad than has been previously described, involving vertigo, diplopia, and the consequences of refeeding syndrome. The development of a full triad and additional symptomatology suggests a late recognition of signs and symptoms of WE in AN. A complicating factor is the overlap between symptoms of thiamine deficiency and the symptoms of WE. Specifically, patients who show rapid weight loss are vulnerable for the development of WE. Eating disorders, such as AN, can lead to WE. Prophylactic thiamine checks and treatment in patients with AN are relevant, and in case of suspicion of WE, adequate parenteral thiamine supplementation is necessary.

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Section: Resultsmentioning

confidence: 99%

Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Oudman

Wijnia

Oey

et al. 2018

Psychiatry Clin Neurosci

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“…To date, the reason why thiamine has not been considered to be involved in the deterioration in BPSD in a general clinical setting may be that TD is not often suspected 7 . In addition, the symptoms of TD are various and can be frequently overlooked as there are no specific symptoms 4,6,10 . In other words, when patients with dementia initially experience a deterioration in BPSD, it may not be thought to be related to the symptoms of TD.…”

Section: Discussionmentioning

confidence: 99%

Exacerbation of psychotic symptoms as clinical presentation of Wernicke encephalopathy in an Alzheimer's disease patient

Uchida

Ishida

Sato

et al. 2020

J of Gen and Family Med

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Although there have been recent reports of nonalcoholic thiamine deficiency (TD), no association has been reported between the exacerbation of the psychiatric symptoms of Alzheimer's disease patient and TD. An 89‐year‐old woman with dementia visited our hospital because of acute deterioration in behavioral and psychological symptoms of dementia (BPSD). Her medical history revealed a decrease in oral food intake lasting more than 2 weeks, so that TD was suspected and abnormal behavior improved significantly after thiamine administration. Thiamine deficiency should be suspected in patients with dementia who demonstrate acute deterioration in BPSD possibly related to poor oral food intake.

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“…Although a characteristic symptom of WE is delirium, no delirium was observed in this case. However, as some cases of WE have been reported without delirium [10,12], it is necessary to differentiate WE from other conditions even when there is no delirium observed as the continued oversight of WE results in Korsakoff syndrome with severe and irreversible brain damage.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the findings that her appetite had begun to decline from 2 months previously and had dropped to only about 30% of normal from 10 days previously, the fact that thiamine stores in the body are depleted in about 18 days [3] as well as reports that WE can present with an absence of consciousness disorders, but only some unsteadiness [4,10], we considered that this patient may have been suffering thiamine deficiency, and thiamine 100 mg in combination with other B-group vitamins was administered twice intravenously, resolving her unsteadiness. Her serum thiamine level, as measured using high-performance liquid chromatography, was abnormally low at 21ng/ml (reference range: 24-66 ng/ml).…”

Section: Case Presentationmentioning

confidence: 99%

A Case of Wernicke Encephalopathy in a Dementia Caregiver: the Need for Nutritional Evaluation in Family Caregivers

Ishida

Uchida²,

Itami

et al. 2020

Preprint

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Background: We report a case in which a family member caring for her mother with dementia developed Wernicke encephalopathy, which is a neuropsychiatric disorder caused by acute/subacute thiamine deficiency, during the course of care. Case presentation: A 63-year-old woman consulted our psychiatric outpatient clinic complaining of difficulty in providing care. She had started caring for her mother with dementia 6 months previously, during which time she began to feel tired. In addition, a loss of appetite had appeared 2 months prior to her visit, and this had decreased to about 30% of normal from 10 days previously. Neurologically, she experienced mild unsteadiness, but she was fully conscious and had no ocular symptoms. Based on the fact that the store of thiamine in the body is exhausted in about 18 days, the possibility of thiamine deficiency was considered, and her unsteadiness disappeared after an intravenous injection of thiamine. Test results showed her serum thiamine level to be abnormally low, and the patient was diagnosed with Wernicke encephalopathy. Conclusions: The burden of caring for a dementia patient may affect the nutritional status of the family caregiver. Thiamine deficiency should be one of the items considered as a nutritional issue in such caregivers.

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Wernicke encephalopathy without delirium in patients with cancer

Abstract: Our report emphasizes the importance of being aware of WE, even when patients do not present with delirium. The presence of loss of appetite for more than two weeks may be the key to a diagnosis of WE.

Cited by 17 publications

References 13 publications

Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Exacerbation of psychotic symptoms as clinical presentation of Wernicke encephalopathy in an Alzheimer's disease patient

A Case of Wernicke Encephalopathy in a Dementia Caregiver: the Need for Nutritional Evaluation in Family Caregivers

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