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Challenges in Diagnosis and Treatment of Wernicke Encephalopathy: Report of 2 Cases
- Source :
- Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 31(2)
- Publication Year :
- 2016
-
Abstract
- Wernicke encephalopathy (WE) is a medical emergency caused by thiamine deficiency, characterized by cerebellar ataxia, ophthalmoplegia, and cognitive disturbances that may progress to Korsakoff amnesia. We describe 2 patients with WE who needed high-dose and long-term treatment with thiamine to obtain neurological improvement and recovery.The first patient was a woman diagnosed with non-Hodgkin lymphoma. After a gastrointestinal infection, she developed depression, memory loss, disorientation, behavioral changes, and ataxic paraplegia. Brain magnetic resonance imaging (MRI) showed bilateral alterations in thalamic, frontal, and periaqueductal regions, suggestive of WE. The second patient was a man who lost 10 kg after surgical gastrectomy; he developed diplopia, ophthalmoplegia, cerebellar ataxia, lower limb paresthesias, and amnesia. A brain MRI demonstrated contrast enhancement of mammillary bodies, compatible with WE.The patients were treated with intramuscular (IM) thiamine (1200 mg/d for 2 months and 900 mg/d for a month, respectively) with gradual cognitive and behavioral improvement and brain MRI normalization, while ataxia and oculomotion improved in following months. In both patients, thiamine was gradually reduced to IM 200 mg/d and continued for a year, without clinical relapses.There is no consensus about dosage, frequency, route, and duration of thiamine administration in WE treatment. Based on our cases, we recommend treating patients with WE with higher doses of IM thiamine for a longer time than suggested (900-1200 mg/d for 1-2 months, in our cases) and to gradually reduce dosage after clinical and radiological improvement, maintaining IM 200 mg/d dosage for at least 1 year.
- Subjects :
- Male
Mammillary body
Medicine (miscellaneous)
Amnesia
Injections, Intramuscular
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Wernicke Encephalopathy
Thiamine
Depression (differential diagnoses)
Aged
Diplopia
Nutrition and Dietetics
Wernicke–Korsakoff syndrome
Cerebellar ataxia
Dose-Response Relationship, Drug
business.industry
Lymphoma, Non-Hodgkin
Brain
Thiamine Deficiency
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Anesthesia
030211 gastroenterology & hepatology
Administration, Intravenous
Female
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 19412452
- Volume :
- 31
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
- Accession number :
- edsair.doi.dedup.....ca28d6cd8de845c17858096b6dd69277