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Wernicke encephalopathy without delirium in patients with cancer.
Palliat Support Care. 2018 Feb; 16(1):118-121.PS

Abstract

OBJECTIVE

Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. Several reports of WE in cancer patients are known. WE is sometimes overlooked because most patients do not exhibit its typical symptoms (e.g., delirium, ataxia, ocular palsy). If delirium is not present, a diagnosis of WE is difficult because delirium is the hallmark symptom of WE.

METHOD

Taken from a series on WE in cancer, we report two patients who developed WE without delirium during periodic psycho-oncology outpatient visits.

RESULTS

Case 1. A 61-year-old woman with non-Hodgkin lymphoma who was periodically attending a psycho-oncology outpatient clinic developed an unsteady gait. WE was suspected because she also developed appetite loss for two weeks, and we could find no other laboratory findings to explain her unsteady gait. Our diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after intravenous thiamine administration. Case 2. A 50-year-old woman with breast carcinoma with bone metastasis developed an unsteady gait. WE was suspected because she also developed loss of appetite for two weeks, and no other laboratory findings could explain her unsteady gait. The diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after administration of intravenous thiamine.

SIGNIFICANCE OF RESULTS

Our report emphasizes the importance of being aware of WE, even when patients do not present with delirium. The presence of loss of appetite for more than two weeks may be the key to a diagnosis of WE.

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Authors+Show Affiliations

Onishi H
Department of Psycho-Oncology,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Ishida M
Department of Psycho-Oncology,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Tanahashi I
Department of Psycho-Oncology,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Takahashi T
Department of Palliative Medicine,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Taji Y
Department of Laboratory Medicine,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Ikebuchi K
Department of Laboratory Medicine,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Furuya D
Department of General Medicine,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Akechi T
Department of Psychiatry and Cognitive-Behavioral Medicine,Graduate School of Medical Sciences,Nagoya City University,Nagoya,Japan.

MeSH

AtaxiaDeliriumFemaleHumansMiddle AgedNeoplasmsThiamineThiamine DeficiencyWernicke Encephalopathy

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28464962

Citation

Onishi, Hideki, et al. "Wernicke Encephalopathy Without Delirium in Patients With Cancer." Palliative & Supportive Care, vol. 16, no. 1, 2018, pp. 118-121.
Onishi H, Ishida M, Tanahashi I, et al. Wernicke encephalopathy without delirium in patients with cancer. Palliat Support Care. 2018;16(1):118-121.
Onishi, H., Ishida, M., Tanahashi, I., Takahashi, T., Taji, Y., Ikebuchi, K., Furuya, D., & Akechi, T. (2018). Wernicke encephalopathy without delirium in patients with cancer. Palliative & Supportive Care, 16(1), 118-121. https://doi.org/10.1017/S1478951517000360
Onishi H, et al. Wernicke Encephalopathy Without Delirium in Patients With Cancer. Palliat Support Care. 2018;16(1):118-121. PubMed PMID: 28464962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Wernicke encephalopathy without delirium in patients with cancer. AU - Onishi,Hideki, AU - Ishida,Mayumi, AU - Tanahashi,Iori, AU - Takahashi,Takao, AU - Taji,Yoshitada, AU - Ikebuchi,Kenji, AU - Furuya,Daisuke, AU - Akechi,Tatsuo, Y1 - 2017/05/03/ PY - 2017/5/4/pubmed PY - 2018/10/3/medline PY - 2017/5/4/entrez KW - Cancer KW - Delirium KW - Thiamine deficiency KW - Vitamin B1 KW - Wernicke encephalopathy SP - 118 EP - 121 JF - Palliative & supportive care JO - Palliat Support Care VL - 16 IS - 1 N2 - OBJECTIVE: Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. Several reports of WE in cancer patients are known. WE is sometimes overlooked because most patients do not exhibit its typical symptoms (e.g., delirium, ataxia, ocular palsy). If delirium is not present, a diagnosis of WE is difficult because delirium is the hallmark symptom of WE. METHOD: Taken from a series on WE in cancer, we report two patients who developed WE without delirium during periodic psycho-oncology outpatient visits. RESULTS: Case 1. A 61-year-old woman with non-Hodgkin lymphoma who was periodically attending a psycho-oncology outpatient clinic developed an unsteady gait. WE was suspected because she also developed appetite loss for two weeks, and we could find no other laboratory findings to explain her unsteady gait. Our diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after intravenous thiamine administration. Case 2. A 50-year-old woman with breast carcinoma with bone metastasis developed an unsteady gait. WE was suspected because she also developed loss of appetite for two weeks, and no other laboratory findings could explain her unsteady gait. The diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after administration of intravenous thiamine. SIGNIFICANCE OF RESULTS: Our report emphasizes the importance of being aware of WE, even when patients do not present with delirium. The presence of loss of appetite for more than two weeks may be the key to a diagnosis of WE. SN - 1478-9523 UR - https://www.unboundmedicine.com/medline/citation/28464962/Wernicke_encephalopathy_without_delirium_in_patients_with_cancer_ L2 - https://www.cambridge.org/core/product/identifier/S1478951517000360/type/journal_article DB - PRIME DP - Unbound Medicine ER -