Cortical damage in Wernicke’s encephalopathy with good prognosis: a report of two cases and literature review

Abstract

Wernicke's encephalopathy (WE) is a thiamine deficiency-related condition, in which lesions are usually present in the periventricular and subcortical areas of the brain. However, lesions have also been found in atypical areas, such as the cerebral cortex. The present study summarizes the clinical outcomes and radiological features of WE with cortical impairment. We report two cases of cortical involvement in patients with WE, and review 22 similar cases from other reports. Among all 24 cases, 4 patients had a confirmed history of chronic daily alcohol abuse, and 19 of them had an identified causes of thiamine deficiency. 17 cases reported specific clinical information, among which 11 patients had symptoms of cortical impairment. 23 cases reported prognostic information at the end of treatment or at follow-up. The mortality rate was 26.1 % in our review. All patients had abnormal magnetic resonance imaging (MRI) signals or pathological findings in the bilateral cortex. Among patients with available MRI, 89.0 % had banding-like signs along the para-central sulcus. 13 cases underwent follow-up MRI examinations and 76.9 % displayed normal images. We suggest that WE with bilateral cortical involvement may have an acceptable prognosis, but that the mortality rate is higher than that among typical cases, especially if patients are not treated promptly and correctly. We identified the frontal and parietal lobes, especially around the central sulcus, to be the most susceptible areas, and suggest that the banding signs may be characteristic of WE. Persistent hyper-intensity on T2-weighted-fluid-attenuated inversion recovery, or gadolinium enhancement, may predict poor outcome.

Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery

“…Cases with pathological findings in the bilateral cortex may lead to a poor outcome. [9] The MR imaging of our case showed hyperintense lesions in the bilateral medial thalami. The classical triad of Wernicke encephalopathy includes ophthalmoplegia, gait ataxia, and altered mental status.…”

Seizure as the Main Manifestation of Nonalcoholic Wernicke’s Encephalopathy but Without Cortical Involvement: A Case Report

“…No exact frequency of seizure was found in the English literature among those with WE. Another retrospective study found that the frontal and parietal lobes, especially around the central sulcus, are the most susceptible areas [ 2 ]. Cortical involvement is usually seen as a sign of irreversible damage and poor prognosis [ 3 ].…”

A case report of Wernicke Korsakoff syndrome in a patient with cholangiocellular carcinoma: An underestimated cause of encephalopathy in cancer patients

“…In order to prevent irreversible brain damage due to untreated Wernicke's encephalopathy, thiamin replacement therapy administered along with dextrose fluid or parenteral nutrition solutions should be considered as prophylactic treatment in hospitalized cancer patients where enteral nutrition cannot be provided for an extended period. Batori et al [5] 1995 1 Gastric cancer Subtotal gastrectomy Arai et al [6] 1997 2 Gastric cancer Total gastrectomy Shimomura et al [7] 1998 3 Gastric cancer Total gastrectomy, subtotal gastrectomy Attard et al [8] 2006 1 Benign gastric tumor** Subtotal gastrectomy Karayiannakis et al [9] 2011 1 Pancreatic cancer Pancreaticoduodenectomy Rufa et al [10] 2011 10 Pancreatic cancer, colon cancer, gallbladder cancer, gallbladder adenoma Abdominal-perineal resection, gastro-entero-anastomosis, hemicolectomy, pancreaticoduodenectomy, cholecystectomy Busani et al [11] 2014 1 Duodenal cancer Pancreaticoduodenectomy Kilinc et al [12] 2015 1* Pancreatic cancer Pancreaticoduodenectomy Wu et al [13] 2016 1* Pancreatic cancer Pancreaticoduodenectomy Restivo et al [14] 2016 19 Gastric cancer, colorectal cancer Total/distal gastrectomy, hemicolectomy, anterior resection, abdominal perineal resection Tozzo et al [15] 2017 1 Gastric cancer Subtotal gastrectomy Tsao et al [16] 2017 1* Gastric cancer Subtotal gastrectomy AbdelRazek et al [17] 2018 1 Pancreatic cancer Pancreaticoduodenectomy Kim et al [18] 2019 1 Ampulla of vater cancer Pancreaticoduodenectomy Fedeli et al [19] 2020 2 Gastric cancer, colorectal cancer Subtotal gastrectomy, anterior resection of rectum Li et al [20] 2021…”

“…The primary malignancies documented in these studies were colorectal, gastric, pancreatic, and gallbladder cancer, pelvic sarcoma, acute myelogenous leukemia, inflammatory breast carcinoma, and multiple myeloma. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] To the best of our knowledge the present case is the first to report a Wernicke's encephalopathy in a patient diagnosed with cholangiocellular carcinoma. Previous case reports of Wernicke's encephalopathy in cancer patients after gastrointestinal surgery are listed in Table 1.…”