Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-25T22:59:21.188Z Has data issue: false hasContentIssue false
  • English
  • Français

Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: A case report and review of the literature

Published online by Cambridge University Press:  13 April 2006

HIDEKI ONISHI ,
YUKIO SUGIMASA ,
CHIAKI KAWANISHI  and
MASANARI ONOSE
HIDEKI ONISHI
Affiliation:
Department of Psychiatry, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
YUKIO SUGIMASA
Affiliation:
Department of Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
CHIAKI KAWANISHI
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
MASANARI ONOSE
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients.

Methods: In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected.

Results and significance of the research: In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Keywords

Vitamin B1 deficiencyCancerDelirium
Type
CASE REPORTS
Information
Palliative & Supportive Care , Volume 3 , Issue 4 , December 2005 , pp. 337 - 340
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press.
Cole, M., Turner, A., & Frank, O. (1969). Extraocular palsy and thiamine therapy in Wernicke's encephalopathy. American Journal of Clinical Nutrition, 22, 44–51.Google Scholar
Davis, R.E. & Icke, G.C. (1983). Clinical chemistry of thiamin. Advances in Clinical Chemistry, 23, 93–140.Google Scholar
Drenick, E.J., Joven, C.B., & Swendseid, M.E. (1966). Occurrence of acute Wernicke's encephalopathy during prolonged starvation for the treatment of obesity. New England Journal of Medicine, 274, 937–939.Google Scholar
Dyer, C.B., Ashtom, C.M., & Teasdale, T.A. (1995). Postoperative delirium. A review of 80 primary data-collection studies. Archives of Internal Medicine, 155, 461–465.Google Scholar
Ebels, E.J. (1978). How common is Wernicke–Korsakoff syndrome? Lancet, 2, 781–782.Google Scholar
Francis, J., Martin, D., & Kapoor, W.N. (1990). A prospective study of delirium in hospitalized elderly. JAMA, 263, 1097–1101.Google Scholar
Harper, C.G., Giles, & M., Finlay-Jones. R. (1986). Clinical signs in the Wernicke–Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy. Journal of Neurology Neurosurgery and Psychiatry, 49, 341–345.Google Scholar
Harper, C., Gold, J., Rodriguez, M., et al. (1989). The prevalence of the Wernicke–Korsakoff syndrome in Sydney, Australia: A prospective necropsy study. Journal of Neurology Neurosurgery and Psychiatry, 52, 282–285.Google Scholar
Hoyumpa, A.M., Jr. (1980). Mechanisms of thiamin deficiency in chronic alcoholism. American Journal of Clinical Nutrition, 33, 2750–2761.Google Scholar
Kondo, K., Fujiwara, M., Murase, M., et al. (1996). Severe acute metabolic acidosis and Wernicke's encephalopathy following chemotherapy with 5-fluorouracil and cisplatin: Case report and review of the literature. Japanese Journal of Clinical Oncology, 26, 234–236.Google Scholar
Lawlor, P.G., Gagnon, B., Mancini, I.L., et al. (2000). Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine, 160, 786–794.Google Scholar
MacLean, L.D., Rhode, B.M., & Shizgal, H.M. (1983). Nutrition following gastric operations for morbid obesity. Annals of Surgery, 198, 3473–3455.Google Scholar
Morita, T., Tei, Y., Tsunoda, J., et al. (2001). Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. Journal of Pain and Symptom Management, 22, 997–1006.Google Scholar
Munir, A., Hussain, S.A., Damanpaul, S., et al. (2001). Wernicke's encephalopathy in a non-alcoholic man. Case report and brief review. Mount Sinai Journal of Medicine, 68, 216–217.Google Scholar
Ogershok, P.R., Rahman, A., Nestor, S., et al. (2002). Wernicke encephalopathy in nonalcoholic patients. American Journal of the Medical Sciences, 323, 107–111.Google Scholar
Onishi, H., Kawanishi, C., Onose, M., et al. (2004). Successful treatment of Wernicke encephalopathy in terminally ill cancer patients: Report of 3 cases and review of the literature. Supportive Care in Cancer, 12, 604–608.Google Scholar
Pereira, J., Hanson, J., & Bruera, E. (1997). The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer, 79, 835–842.Google Scholar
Reuler, J.B., Girard, D.E., & Cooney, T.G. (1985). Current concepts. Wernicke's encephalopathy. New England Journal of Medicine, 312, 1035–1039.Google Scholar
Stiefel, F., Fainsinger, R., & Bruera, E. (1992). Acute confusional states in patients with advanced cancer. Journal of Pain and Symptom Management, 7, 94–98.Google Scholar
Trzepacz, P.T., Baker, R.W., & Greenhouse, J. (1988). A symptom rating scale for delirium. Psychiatry Research, 23, 89–97.Google Scholar
van Zaanen, H.C. & van der Lelie, J. (1992). Thiamine deficiency in hematologic malignant tumors. Cancer, 69, 1710–1713.Google Scholar
Zubaran, C., Fernandes, J.G., & Rondnight, R. (1997). Wernicke–Korsakoff syndrome. Postgraduate Medical Journal, 73, 27–31.Google Scholar