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Wernicke encephalopathy without delirium that appeared as agitation in a patient with lung cancer

Published online by Cambridge University Press:  11 May 2018

Hideki Onishi ,
Mayumi Ishida ,
Takao Takahashi ,
Yoshitada Taji ,
Kenji Ikebuchi ,
Daisuke Furuya ,
Nozomu Uchida  and
Tatsuo Akechi
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Takao Takahashi
Affiliation:
Department of Palliative Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Yoshitada Taji
Affiliation:
Department of Laboratory Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Kenji Ikebuchi
Affiliation:
Department of Laboratory Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Daisuke Furuya
Affiliation:
Department of General Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University Saitama International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan E-mail: [email protected]
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Abstract

Objective

Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency, and is sometimes overlooked because of the diversity of clinical symptoms.

Method

From a series of WE patients with cancer, we report a lung cancer patient who developed WE, the main symptom of which was agitation.

Result

A 50-year-old woman with lung cancer was referred to our psycho-oncology clinic because of agitation lasting for three days. No laboratory findings or drugs explaining her agitation were identified. Although the patient did not develop delirium, ophthalmoplegia, or ataxia, WE was suspected because she experienced a loss of appetite loss lasting 5 weeks. This diagnosis was supported by abnormal serum thiamine and disappearance of agitation one hour after intravenous thiamine administration.

Significance of results

This report emphasizes the clinical diversity of WE and indicates the limits of the ability to diagnose WE from typical clinical symptoms. The presence of a loss of appetite for more than two weeks may be the key to the accurate diagnosis of WE.

Keywords

Wernicke encephalopathythiamine deficiencyagitationdelirium
Type
Case Report
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 800 - 802
Copyright
Copyright © Cambridge University Press 2018 

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References

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders 5th edition, Washington DC: American Psychiatric Publishing.Google Scholar
Harper, CG, Giles, M and 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(4), 341–345.Google Scholar
Isenberg-Grzeda, E, Kutner, HE and Nicolson, SE (2012) Wernicke-Korsakoff-syndrome: under-recognized and under-treated. Psychosomatics 53(6), 507–516.Google Scholar
Isenberg-Grzeda, E et al. (2016a). Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff syndrome) among inpatients with cancer: A series of 18 cases. Psychosomatics 57(1), 71–81.Google Scholar
Isenberg-Grzeda, E et al. (2016b) Wernicke-Korsakoff syndrome in patients with cancer: A systematic review. Lancet Oncology 17(4), e142–e148.Google Scholar
MacLean, LD, Rhode, BM and Shizgal, HM (1983). Nutrition following gastric operations for morbid obesity. Annals of Surgery 198(3), 347–355.Google Scholar
Onishi, H et al. (2018) Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic. Palliative and Supportive Care 1–4. Epub ahead of print Feb 26, 2018.Google Scholar
Onishi, H et al. (2017a) Subclinical thiamine deficiency in patients with abdominal cancer. Palliative and Supportive Care 1–3. Epub ahead of print Dec 26, 2017.Google Scholar
Onishi, H et al. (2017b) Wernicke encephalopathy without delirium in patients with cancer. Palliative and Supportive Care 16(1):118–121.Google Scholar
Onishi, H et al. (2016) Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. Palliative and Supportive Care 14(3), 302–306.Google Scholar
Onishi, H 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(8), 604–608.Google Scholar
Sechi, G et al. (2016a) Cancer-related Wernicke-Korsakoff syndrome. Lancet Oncology 17(6), e221–e222.Google Scholar
Sechi, G et al. (2016b) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutrition Reviews 74(5), 281–300.Google Scholar
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurology 6(5), 442–455.Google Scholar
Thomson, AD et al. (2008) Wernicke's encephalopathy revisited. Translation of the case history section of the original manuscript by Carl Wernicke ‘Lehrbuch der Gehirnkrankheiten fur Aerzte and Studirende’ (1881) with a commentary. Alcohol and Alcoholism 43(2), 174–179.Google Scholar
Victor, M, Adams, RD and Collins, GH (1971). The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemporary Neurology Series 7, 1–206.Google Scholar