Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy

Abstract

Clinicians must be aware of the possibility of Wernicke encephalopathy in cancer patients, especially in those with loss of appetite for longer than 18 days. The degree of appetite loss in such patients might serve as a reference. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab

“…Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by a deficiency of thiamine that, in its biologically active form, thiamine pyrophosphate, is necessary for oxidative metabolism (Sechi & Serra, 2007). This disorder is reversible if properly diagnosed and treated with parenteral thiamine administration; however, this disorder often goes unrecognized because of the diversity of symptoms (Isenberg-Grzeda et al, 2012; Onishi et al, 2016; Sechi et al, 2016b). If left untreated, it causes severe and irreversible brain damage (Korsakoff syndrome), leading to death.…”

Exacerbation of psychotic symptoms as clinical presentation of Wernicke encephalopathy in an Alzheimer's disease patient

“…To date, the reason why thiamine has not been considered to be involved in the deterioration in BPSD in a general clinical setting may be that TD is not often suspected 7 . In addition, the symptoms of TD are various and can be frequently overlooked as there are no specific symptoms 4,6,10 . In other words, when patients with dementia initially experience a deterioration in BPSD, it may not be thought to be related to the symptoms of TD.…”

“…However, humans cannot synthesize thiamine, so they are reliant on intake from external sources 2 . As the store of thiamine in the body is depleted in as few as about 18 days, 3 thiamine deficiency (TD) may occur if anorexia or similar conditions last for 2‐3 weeks 2,4 . Such TD typically leads to Wernicke encephalopathy (WE) 1 .…”

“…Treatment consists of the intravenous administration of thiamine, and if it is discovered and treated early, patients generally recover without complications 1,5 . However, the classical triad of symptoms show low disease specificity and not all symptoms are always present; therefore, the diagnosis of WE is often overlooked 4,6 …”

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

“…This disorder is reversible if properly diagnosed and treated with supplementary thiamine; however, it often goes unrecognized because of the diversity of symptoms (Isenberg-Grzeda et al, 2012; Onishi et al, 2016; Sechi et al, 2016b). If left untreated, it can cause severe and irreversible brain damage (Korsakoff syndrome), leading to death.…”