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Challenges in Diagnosis and Treatment of Wernicke Encephalopathy
Author(s) -
Infante Maria Teresa,
Fancellu Roberto,
Murialdo Alessandra,
Barletta Laura,
Castellan Lucio,
Serrati Carlo
Publication year - 2016
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0884533615621753
Subject(s) - medicine , thiamine , ataxia , wernicke's encephalopathy , mammillary body , encephalopathy , amnesia , wernicke encephalopathy , retrograde amnesia , magnetic resonance imaging , surgery , anesthesia , pediatrics , gastroenterology , radiology , psychiatry , hippocampus , thiamine deficiency
Background: Wernicke encephalopathy (WE) is a medical emergency caused by thiamine deficiency, characterized by cerebellar ataxia, ophthalmoplegia, and cognitive disturbances that may progress to Korsakoff amnesia. We describe 2 patients with WE who needed high‐dose and long‐term treatment with thiamine to obtain neurological improvement and recovery. Case Description: The first patient was a woman diagnosed with non‐Hodgkin lymphoma. After a gastrointestinal infection, she developed depression, memory loss, disorientation, behavioral changes, and ataxic paraplegia. Brain magnetic resonance imaging (MRI) showed bilateral alterations in thalamic, frontal, and periaqueductal regions, suggestive of WE. The second patient was a man who lost 10 kg after surgical gastrectomy; he developed diplopia, ophthalmoplegia, cerebellar ataxia, lower limb paresthesias, and amnesia. A brain MRI demonstrated contrast enhancement of mammillary bodies, compatible with WE. Outcome: The patients were treated with intramuscular (IM) thiamine (1200 mg/d for 2 months and 900 mg/d for a month, respectively) with gradual cognitive and behavioral improvement and brain MRI normalization, while ataxia and oculomotion improved in following months. In both patients, thiamine was gradually reduced to IM 200 mg/d and continued for a year, without clinical relapses. Conclusions: There is no consensus about dosage, frequency, route, and duration of thiamine administration in WE treatment. Based on our cases, we recommend treating patients with WE with higher doses of IM thiamine for a longer time than suggested (900–1200 mg/d for 1–2 months, in our cases) and to gradually reduce dosage after clinical and radiological improvement, maintaining IM 200 mg/d dosage for at least 1 year.