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Wernicke's encephalopathy in a malnourished surgical patient: a difficult diagnosis.
BMC Res Notes. 2014 Oct 14; 7:718.BR

Abstract

BACKGROUND

Wernicke's encephalopathy is an acute neurological disorder resulting from thiamine deficiency mainly related to alcohol abuse. Severe thiamine deficiency is an emerging problem in non-alcoholic patients and it may develop in postoperative surgical patients with risk factors.

CASE PRESENTATION

We reported a case of a 46 years old woman who underwent, one year before, to cephalic duodenopancreatectomy complicated with prolonged recurrent vomiting. She underwent to a second surgical operation for intestinal sub-occlusion and postoperatively she developed septic shock and hemorrhagic Wernicke's disease. After ICU admission, because of neurological deterioration, she underwent CT scan and MRI that highlighted a strong suspicion for Wernicke's disease. We treated her with an initially wrong low dose of thiamine, then after MRI we increased the dosage with a neurological status improvement. Despite therapeutic efforts used to control septic shock and thrombocytopenia, she died on the 21st day after surgery because of massive cerebral bleeding and unresponsive cerebral edema.

CONCLUSION

Early detection of subclinical thiamine deficiency is a difficult task, as symptoms may be nonspecific. Wernicke's disease remains a clinical diagnosis because there are no specific diagnostic abnormalities revealed in cerebrospinal fluid, electroencephalogram or evoked potentials. About this, the best aid for a correct diagnosis is the clinical suspicion and clinicians should consider the disorder in any patients with unbalanced nutrition, increased metabolism or impaired food absorption. A hallmark of our case was the brain hemorrhage in the typical areas of the Wernicke's disease, maybe triggered by the thrombocytopenia secondary to sepsis. It might be a good clinical practice administer thiamine to all patients presenting with coma or stupor and risk factors related with thiamine deficiency. Any therapeutic delay may result in permanent neurological damage or death.

Authors+Show Affiliations

Cattedra di Anestesia e Rianimazione, Policlinico di Modena, Università di Modena e Reggio Emilia, Modena, Italy. stefanobusani7@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25312751

Citation

Busani, Stefano, et al. "Wernicke's Encephalopathy in a Malnourished Surgical Patient: a Difficult Diagnosis." BMC Research Notes, vol. 7, 2014, p. 718.
Busani S, Bonvecchio C, Gaspari A, et al. Wernicke's encephalopathy in a malnourished surgical patient: a difficult diagnosis. BMC Res Notes. 2014;7:718.
Busani, S., Bonvecchio, C., Gaspari, A., Malagoli, M., Todeschini, A., Cautero, N., & Girardis, M. (2014). Wernicke's encephalopathy in a malnourished surgical patient: a difficult diagnosis. BMC Research Notes, 7, 718. https://doi.org/10.1186/1756-0500-7-718
Busani S, et al. Wernicke's Encephalopathy in a Malnourished Surgical Patient: a Difficult Diagnosis. BMC Res Notes. 2014 Oct 14;7:718. PubMed PMID: 25312751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Wernicke's encephalopathy in a malnourished surgical patient: a difficult diagnosis. AU - Busani,Stefano, AU - Bonvecchio,Cinzia, AU - Gaspari,Arianna, AU - Malagoli,Marcella, AU - Todeschini,Alessandra, AU - Cautero,Nicola, AU - Girardis,Massimo, Y1 - 2014/10/14/ PY - 2014/04/11/received PY - 2014/10/08/accepted PY - 2014/10/15/entrez PY - 2014/10/15/pubmed PY - 2015/6/27/medline SP - 718 EP - 718 JF - BMC research notes JO - BMC Res Notes VL - 7 N2 - BACKGROUND: Wernicke's encephalopathy is an acute neurological disorder resulting from thiamine deficiency mainly related to alcohol abuse. Severe thiamine deficiency is an emerging problem in non-alcoholic patients and it may develop in postoperative surgical patients with risk factors. CASE PRESENTATION: We reported a case of a 46 years old woman who underwent, one year before, to cephalic duodenopancreatectomy complicated with prolonged recurrent vomiting. She underwent to a second surgical operation for intestinal sub-occlusion and postoperatively she developed septic shock and hemorrhagic Wernicke's disease. After ICU admission, because of neurological deterioration, she underwent CT scan and MRI that highlighted a strong suspicion for Wernicke's disease. We treated her with an initially wrong low dose of thiamine, then after MRI we increased the dosage with a neurological status improvement. Despite therapeutic efforts used to control septic shock and thrombocytopenia, she died on the 21st day after surgery because of massive cerebral bleeding and unresponsive cerebral edema. CONCLUSION: Early detection of subclinical thiamine deficiency is a difficult task, as symptoms may be nonspecific. Wernicke's disease remains a clinical diagnosis because there are no specific diagnostic abnormalities revealed in cerebrospinal fluid, electroencephalogram or evoked potentials. About this, the best aid for a correct diagnosis is the clinical suspicion and clinicians should consider the disorder in any patients with unbalanced nutrition, increased metabolism or impaired food absorption. A hallmark of our case was the brain hemorrhage in the typical areas of the Wernicke's disease, maybe triggered by the thrombocytopenia secondary to sepsis. It might be a good clinical practice administer thiamine to all patients presenting with coma or stupor and risk factors related with thiamine deficiency. Any therapeutic delay may result in permanent neurological damage or death. SN - 1756-0500 UR - https://www.unboundmedicine.com/medline/citation/25312751/Wernicke's_encephalopathy_in_a_malnourished_surgical_patient:_a_difficult_diagnosis_ DB - PRIME DP - Unbound Medicine ER -