Iatrogenic Wernicke’s encephalopathy in allogeneic bone marrow transplantation: a study of eight cases

Abstract

Summary:to carbohydrate metabolism, any increase in carbohydrate intake will also raise the need for thiamine to metabolize it, and may constitute an immediate precipitating factor for Wernicke's encephalopathy (WE) is a neuropsychiatric condition generally caused by acute thiamine deficiency some syndromes such as WE. First described by Carl Wernicke, in 1881, 7 WE is an acute neuropsychiatric condition and classically involves the triad of altered mentation, ataxia and ophthalmoplegia. It is most common among caused by thiamine deficiency. It classically involves the triad of ataxia, ophthalmoplegia and altered mental state. 6-8 alcoholics, but several other causes have been identified, including total parenteral nutrition (TPN) use. We It may be followed by a state of amnesia and confabulation, known as Korsakoff psychosis 8 which may cause death in present eight cases of WE in patients undergoing allogeneic BMT, where thiamine deficiency was caused by some patients. We present eight cases of iatrogenic WE in patients undergoing allogeneic BMT. These patients a lack of vitamin supplementation during TPN administration. Clinically, WE presented as a severe refractory presented with severe metabolic acidosis, preceded by a 'raspberry tongue' and followed by the subclinical findings metabolic acidosis, preceded by 'raspberry tongue', and ophthalmologic and neurologic dysfunction. The sites of WE. The final diagnosis was made only after autopsy examination. Data presented here represent the largest sermost affected were the periventricular structures and the thalamus, and no mammilary bodies lesions were ies in the literature and should alert physicians to this unusual entity in BMT patients, alerting them to WE as a found. Keywords: Wernicke's encephalopathy; leukemia; allopossible BMT complication. 9,10 geneic bone marrow transplantation; thiamine deficiency Patients and methods BMT is the treatment of choice for a wide variety of hema-A total of 96 allogeneic BMT were undertaken from Janutological, non-hematological, genetic and immune disary 1988 to May 1990. Autopsy materials from the fatal eases. 1 However, aside from the prolonged neutropenia and cases were studied, and eight cases with WE-like neurorisk of opportunistic infection, 2,3 conditioning may cause pathological abnormalities were diagnosed. There were five several side-effects including nausea, vomiting, mucositis females and three males with ages ranging from 14 to 37 and diarrhea, 4 leading to a reduced caloric intake and malyears (median 25 years). Diagnoses were AML in four, absorption. These complications necessitate TPN regimens CML in two and ALL in two patients. Medical records and their attendant complications. Thiamine, also known as were reviewed for conditioning regimen, clinical course vitamin B1, is a water soluble vitamin, formed by a pyrimand neuropathological features. idine and a thiazole ring linked through a methylene group. 5 In the tissues, thiamine is phosphorylated to its most active BMT procedures coenzyme form, thiamin...

Neurological complications of hematopoietic stem cell transplantation (HSCT): a retrospective study in a HSCT center in Brazil

“…In most of the cases we observed disturbances in consciousness, characterized by somnolence, torpor and coma; metabolic acidosis; and an uncommon form of optical neuritis. the mortality rate was high, and all cases were confirmed by autopsy 24 . After a 25-year-old patient who had a very suggestive clinical picture of WE had been diagnosed with thiamin deficiency, the remaining patients in this WE series were diagnosed retrospectively.…”

Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases

“…Furthermore, our patients also presented with a 'raspberry tongue', which may be an important clinical finding in the early detection of iatrogenic WE. 18 Histologically, all had focal periventricular lesions of the gray matter in the medulla oblongata, which is a very characteristic finding of WE. 20 The hypothalamus was the second most affected area.…”

“…WE is characterized by a classical triad of altered mental status, ataxia and ophthalmoplegia, 18 but the clinical course is usually oligosymptomatic. 19 Mental status changes are the most frequent findings in these patients (82%), followed by ocular findings (29%), and ataxia (23%).…”

Thiamine-Responsive Acute Neurological Disorders in Nonalcoholic Patients

“…Thus it seems that unlike chronic alcoholics, nonalcoholic patients have a better prognosis, and are less prone to develop Korsakoff’s syndrome when suffering from thiamine deficiency. It should be noted, however, that failure to recognize this entity often also leads to a fatal outcome in nonalcoholics [8, 9]. Our report suggests that WE episodes in nonalcoholics are not uncommon.…”

“…hyperemesis gravidarum) [5, 6], starvation or pure dietary thiamine deficiency [4, 7], prolonged critical care and parenteral nutrition with inadequate vitamin supplementation [8, 9], gastroplastic surgery [10, 11], hemodialysis and malignant disorders (usually of the gastrointestinal tract) [12]. Seven of the cases in our series belong to one of these categories, while the remaining 2 patients (3 and 6) suffered recurrent bouts without a clear precipitating event.…”