Nonalcoholic Wernicke’s encephalopathy: a retrospective study of 17 cases

Abstract

ObjectiveNonalcoholic Wernicke’s encephalopathy (WE) is a devastating neuropsychiatric syndrome caused by thiamine deficiency. Although many case reports on WE have been published, more studies are required to guide the diagnosis and treatment of nonalcoholic WE.MethodsWe retrospectively studied patients who were diagnosed with WE in our hospital. Data on demographics, possible causes, phenomenology, and diagnostic and treatment delays were abstracted from medical records by chart reviews.ResultsSeventeen patients were diagnosed with nonalcoholic WE. Nonalcoholic WE had many causes, such as gastrointestinal surgery, gastrointestinal tract diseases, vomiting, and psychiatric diseases. Most patients presented with abnormal mental symptoms, including those in a coma.ConclusionIn summary, we recommend using operational criteria to diagnose and treat nonalcoholic WE as early as possible to avoid misdiagnosis and treatment delays. Nonalcoholic WE remains a clinical diagnosis, and certain examinations are helpful for this diagnosis, such as measuring serum thiamine concentrations. We should focus on patients who present with abnormal mental symptoms, even those in a coma, and administer parenteral thiamine before any carbohydrate to reduce the high frequency of residual morbidity.

Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient

“…Однако определение сывороточного магния не относится к рутинному биохимическому исследованию и не было выполнено в данном случае. Энцефалопатия Вернике у пациентов, не страдающих алкоголизмом, имеет в основном сложные клинические проявления и атипичное развитие заболевания [3,5,10,11]. Наш пациент в этом плане оказался исключением.…”

“…Несмотря на указанную редкость патологии, только за последние несколько лет описано большое число клинических наблюдений энцефалопатии Вернике у пациентов, не злоупотребляющих алкоголем: при желудочно-кишечных расстройствах различного генеза (оперативные вмешательства, он ко ло ги че ские заболевания, беременность и др. ), голодании или строгих диетических ограничениях (строгое соблюдение поста), гипотрофии, нервной анорексии, травме головного мозга, энцефалите с поражением базальных ядер и височных долей, отравлении угарным газом [5][6][7][8][9][10][11][12][13]. Представляют интерес наблюдения энцефалопатии Верника у пациентов, перенесших трансплантацию печени, костного мозга, гемопоэтических стволовых клеток [14][15][16].…”

Wernicke's encephalopathy in a rectal cancer patient with atypical radiological features: A case report

“…Lesions can also be found atypically in the cerebellum, cranial nerve nucleus, red nucleus, caudate nucleus, cerebral cortex, and other atypical areas. Atypical findings are found more frequently in nonalcoholic patients[ 10 ]. Cerebellum involvement on imaging is rare, but autopsy studies have demonstrated that the anterior-superior vermis or anterior hemisphere is affected in more than half of patients with Wernicke’s encephalopathy.…”

Isolated Pulvinar/Hockey Stick Sign in Nonalcoholic Wernicke’s Encephalopathy

“…These include the medial thalami (85%), third ventricle (80%), periaqueductal gray matter (59%), mammillary bodies (45%), and the tectal plate (36%). Less commonly affected areas include the cranial nerve nuclei (18%), periventricular gray matter anterior to the fourth ventricle (7%), cerebellum (5%), vermis (4%), dentate nuclei (1.8%), and the precentral and postcentral cortices (1.8%) [ 1 , 2 , 5 , 23 ]. However, in both of our cases, the medial thalami were the only structures involved, thus adding to the diagnostic dilemma.…”

“…Pulvinar/hockey stick signs have high specificity for vCJD [ 26 ] but can be seen in various other pathologies ( Table 3 ). Appropriate identification of these signs on MRI in combination with a patient’s clinical presentation is critical for appropriate diagnosis and treatment [ 23 ]. Patient A was diagnosed with vCJD because of the isolated pulvinar sign.…”