Wernicke‐Korsakoff Syndrome following Small Bowel Obstruction

Abstract

We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention.

Non-alcoholic Korsakoff syndrome in psychiatric patients with a history of undiagnosed Wernicke's encephalopathy

“…In all nine previously reported cases of non-alcoholic KS where delayed memory was tested, it was found impaired [12][13][14][15][16][17][18][19]. Immediate memory was impaired in five of eight tested cases [13][14][15][16]20], in one case it was reported as unaffected but test results appear to indicate impairment [19], in one case impairment receded during follow-up [12], and in one case immediate memory was normal [17]. Recognition was impaired in all three tested cases [12,14,19].…”

“…Intrusions (provoked confabulations) in neuropsychological testing indicate organic brain damage, including alcoholic KS [23][24][25]. In two previously reported cases of non-alcoholic KS intrusions were reported [15,19], whereas in another case there were no intrusions [14]. In alcoholic KS executive functions are impaired [26].…”

“…However, recent studies have shown that KS often follows non-alcoholic WE [4,7,11]. Still, results of a neuropsychological examination have been reported for only ten cases [12][13][14][15][16][17][18][19][20]. There are no diffusion tensor imaging (DTI) studies.…”

Need for Thiamine in Peripheral Parenteral Nutrition After Abdominal Surgery in Children

“…23 Therefore, in children requiring PPN >5 days after abdominal surgery, the addition of thiamine to the PPN solution should be strongly considered. 6,7,15,24 In addition, clinicians should note the patient's postoperative condition with regard to TD, because some reports show that the recovery of TD requires >2 weeks. 25,26 The daily dose of thiamine in PPN is also unclear.…”

Glucose before Thiamine for Wernicke Encephalopathy: A Literature Review

“…In the United States, it is most commonly seen in alcoholics, but can also be found in any malnourished state; patients with hyperemesis gravidarum, intestinal obstruction, acquired immunodeficiency syndrome, gastric bypass, and malignancies are commonly cited (1)(2)(3)(4)(5). The typical symptoms include confusion, ocular abnormalities, and ataxia.…”