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Case Report:wernicke encephalopathy following splenectomy in a patient with liver cirrhosis:a case report and review of the literature

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2010年第6期11卷 433-436页

作者： Xia-ping ZHANG Yuan-qiang LU Wei-dong HUANG Department of Emergency the First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China

Objective:To report a case of wernicke encephalopathy in the early stage after ***:A nonalcoholic female patient with hepatitis B-related cirrhosis and hypersplenism underwent splenectomy in a local *** surgical complications occurred and the patient recovered ***,on the eighth postoperative day she developed psychiatric and neurological disturbance without an obvious *** was then admitted to our *** magnetic resonance imaging(MRI) with FLAIR T2 showed symmetric high-signal intensities in the periaqueductal area of the midbrain,which were consistent with wernicke *** was thus given in-tramuscular thiamine ***:After the administration of thiamine,the patient's confused mental state resolved within 3 d,and her dystaxia gradually improved over the next 5 *** brain MRI with FLAIR T2 was re-examined one month after the episode,and showed nearly complete resolution of the previously abnormal signal intensities in the periaqueductal area of the ***:Physicians should be aware of the possibility of acute wernicke encephalopathy,especially in patients with liver dysfunction.

关键词： wernicke encephalopathy Liver cirrhosis Thiamine Splenectomy

wernicke encephalopathy Clinical presentation and MR images in two nonalcoholic patients

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Neural Regeneration Research 2008年第4期3卷 461-464页

作者： He Zhang Jun Wu Zhiping Hu Bo Xiao Guoliang Li Department of Neurology Xiangya Second Hospital Central South University Changsha 410011 Hunan Province China Department of Neurology Xiangya Hospital Central South University Changsha 410011 Hunan Province China

The aim of the present study was to investigate the importance of and correlation between clinical presentations and magnetic resonance imaging （MRI） of two different cases of nonalcoholic wernicke encephalopathy. Case l ： A 63-year-old man with a diagnosis of incomplete mechanical intestinal obstruction. His abdominal symptoms were improved by gastrointestinal decompression, but blurred vision, hypoacusis, dizziness, and unsteady gait were noted. His illness deteriorated to confusion on day seven. MRI showed hyperintense lesions in the medial thalami, tectum of the midbrain, and the periaqueduct region on T2- and diffusion-weighted images. Thiamine therapy was commenced immediately with good results. Case 2： A 22-year-old woman was admitted for sudden-onset confabulation and unsteady gait after hyperemesis gravidarum. She had no history of alcohol or any medication. Brain MRI was normal. The patient experienced relief after Vitamin B1 treatment. These results suggest that brain MRI can define characteristic abnormalities in wernicke encephalopathy, and that diffusion-weighted imaging may improve the diagnosis sensitivity. In addition, the MRI images may be correlated to the clinical stage and severity of the disease. Nevertheless, the clinical features are essential for correct diagnosis.

关键词： wernicke encephalopathy magnetic resonance imaging clinical presentation

wernicke encephalopathy in a patient after liver transplantation: A case report

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World Journal of Gastroenterology 2017年第47期23卷 8432-8436页

作者： Bin Xie Zhong-Zhou Si Wei-Ting Tang Hai-Zhi Qi Ting Li Organ Trans-plantation Center The Second Xiang-ya Hospital Central South University Department of Neurology Xiang-ya Hospital Central South University

wernicke encephalopathy(WE) is an acute neurological disorder resulting from vitamin B1 deficiency, which is common in chronic alcoholism and is rare in acute liver failure. So far, there are 2 cases of WE reported after liver transplantation. Here, we report a case of a 45-year-old nonalcoholic male patient who developed psychiatric and neurological disturbance 15 d after receiving orthotopic liver transplantation because of hepatitis B-related cirrhosis and portal hypertension. Brain magnetic resonance imaging(MRI) showed symmetric high-signal intensities in the periaqueductal area. The patient was diagnosed with WE and given intravenous high-dose vitamin B1 immediately. His neurological disturbance resolved in 7 d after receiving the vitamin B1. Brain MRI after 5 mo showed nearly complete recovery. Most WE cases may be misdiagnosed in patients after liver transplantation, and we should pay more attention to its onset.

关键词： Liver transplantation Thiamine deficiency wernicke encephalopathy Magnetic resonance imaging Prevention Pharmacotherapy

Pancreatic encephalopathy and wernicke encephalopathy in association with acute pancreatitis: A clinical study

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World Journal of Gastroenterology 2006年第26期12卷 4224-4227页

作者： Guo-Hui Sun Yun-Sheng Yang Qing-Sen Liu Liu-Fang Cheng Xu-Sheng Huang Department of Gastroenterology Chinese PLA General Hospital Beijing 100853 China Department of Neurology Chinese PLA General Hospital Beijing 100853 China

AIM： To investigate clinical characteristics and therapy of pancreatic encephalopathy （PE） and wernicke encephalopathy （WE）. METHODS： In a retrospective study of 596 patients with acute pancreatitis （AP）, patients with PE were compared to those with WE in regards to history, clinical manifestation, diagnosis, treatment and outcome. RESULTS： There were 93 patients with severe acute pancreatitis （SAP）. Encephalopathies were discovered in 10 patients （1.7%）. Six patients with PE all developed in SAP （6.5%）, and three of them died （3% of SAP, 50% of PE）. Four patients with WE developed in AP （0.7%）, and two of them died （0.3% of AP, 50% of WE）. Two patients with WE were treated with parenteral thiamine and survived. Global confusions were seen in all patients with encephalopathy. Ocular abnormalities were found. Conjugate gaze palsies were seen in 1 of 6 （16.7%） patients with PE. Of 4 patients with WE, one （25%） had conjugate gaze palsies, two （50%） had horizontal nystagmus, three （75%） had diplopia, and one （25%） had myosis. Ataxia was not seen in all patients. None of patients with WE presented with the classic clinical triad. CSF examinations for 2 patients with WE showed lightlyincreased proteins and glucose. CT and MRI of the brain had no evidence of characteristic abnormalities. CONCLUSION： PE occurs in early or reiteration stage of SAP, and WE in restoration stage of SAP/AP. Ocular abnormalities are the hallmarks of WE, and horizontal nystagmus is common. It is difficult to diagnose earlier an encephalopathy as PE or WE, as well as differentiate one from the other. Long fasting, hyperemesis and total enteral nutrition （TPN） without thiamine are main causes of thiamine deficiency in the course of pancreatitis.

关键词： Pancreatic encephalopathy wernicke encephalopathy Acute pancreatitis Thiamine Total parenteral nutrition

Clinical analysis of wernicke encephalopathy after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2023年第4期22卷 352-357页

作者： Li-Min Ding Li-Shan Deng Jun-Jie Qian Gang Liu Lin Zhou Shu-Sen Zheng Division of Hepatobiliary Pancreatic Surgery the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China NHFPC Key Laboratory of Combined Multi-organ Transplantation Hangzhou 310003China Key Laboratory of the Diagnosis and Treatment of Organ Transplantation Chinese Academy of Medical SciencesHangzhou 310003China Key Laboratory of Organ Transplantation Research Center for Diagnosis and Treatment of Hepatobiliary DiseasesHangzhou 310003China Culture and Sports Center for the Disabled of Jiangxi Province Nanchang 330000China Department of Transplantation Jiangxi Provincial People’s HospitalNanchang 330000China Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases Hangzhou 310003China

Background:wernicke encephalopathy(WE)is an acute neurological disease resulting from vitamin B1 deficiency,and there are only very few case reports of WE after liver *** present study aimed to investigate the clinical characteristics,etiology,magnetic resonance imaging(MRI)features,treatment and prognosis of patients with WE after liver ***:Twenty-three patients with WE after liver transplantation from the First Affiliated Hospital,Zhejiang University School of Medicine and Jiangxi Provincial People’s Hospital between January 2011 and December 2021 were retrospectively ***:Among the 23 patients diagnosed with WE after liver transplantation,6(26%)had a classic triad of impaired consciousness,oculomotor palsy and ataxia,and 17(74%)had two *** misdiagno-sis rate was 65%.After treatment with high-dose vitamin B1,19(83%)patients showed improvement,whereas 4(17%)showed no improvement,including 3 with residual short-term memory impairments and 1 with residual spatial and temporal disorientation and ***:The misdiagnosis rate is high in the early stage of WE,and the prognosis is closely asso-ciated with whether WE is diagnosed early and treated ***-dose glucose or glucocorticoids can trigger WE and cannot be administered before vitamin B1 *** B1 is suggested to be used as a prophylactic treatment for patients with WE after liver transplantation.

关键词： Liver transplantation wernicke encephalopathy Vitamin B1 Clinical presentations Imaging features Diagnosis Treatment Prognosis

Non-alcoholic wernicke encephalopathy in an esophageal cancer patient receiving radiotherapy:A case report

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World Journal of Clinical Cases 2022年第17期10卷 5810-5815页

作者： Ye Zhang Lei Wang Jin Jiang Wen-Yu Chen Department of General Practice The Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina Department of Oncology The Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina Department of Respiration The Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina

BACKGROUND, wernicke encephalopathy is a rare but potentially fatal adverse event caused by thiamine deficiency. Reports of non-alcoholic wernicke encephalopathy due to malignancy are scarce in the literature, with those reported mainly being on haematological cancer, followed by gastrointestinal cancer. As a result, there is considerable under-recognition and delay in the diagnosis and treatment of wernicke encephalopathy in oncology departments. To our knowledge, there has been no report of wernicke encephalopathy in a patient with esophageal cancer while receiving *** SUMMARY A 64-year-old man presented to the oncology outpatient clinic with a history of dysphagia for 2 mo, and was diagnosed with locally advanced esophageal squamous cell carcinoma(stage ⅢB). Radiotherapy was initiated to alleviate dysphagia due to malignant esophageal stenosis;however, the patient exhibited consciousness disturbances starting on day 10 of radiotherapy. Brain magnetic resonance imaging indicated the development of wernicke encephalopathy. Subsequent treatment with thiamine led to rapid improvement in the patient’s neurological *** wernicke encephalopathy may develop in non-alcoholic patients undergoing radiotherapy for esophageal cancer. Early diagnosis and sufficient thiamine supplementation during radiotherapy are essential.

关键词： wernicke encephalopathy Thiamine deficiency Esophageal cancer Radiotherapy Consciousness disturbance Case report

wernicke encephalopathy in a Patient with Pulmonary and Abdominal Tuberculosis

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Chinese Medical Journal 2017年第22期130卷 2757-2758页

作者： Yun-Cui Gan Jing Jin Zhi-Xin Qiu Xue-Rong Chen Department of Pulmonary and Critical Care Medicine West China Hospital Sichuan University Chengdu Sichuan 610041 China

wernicke encephalopathy （WE） is an acute or subacute neurological syndrome caused by thiamine （Vitamin B 1） deficiency and is usually underestimated in clinical practice. WE is suspected in merely about 6% of non-alcoholic patients and one-third of alcoholic patients, Non-alcoholic causes include gastrointestinal surgery and disease, malnutrition, cancer and chemotherapeutic treatments, and long-term parenteral ***, few cases were reported about WE in patients with tuberculosis. Early diagnosis and medication are vital for the prognosis of this disease.

关键词： Cerebellar Ataxia Mental Disorder Ophthalmoplegia Thiamine Deficiency Tuberculosis wernicke encephalopathy

Atypical miller-fisher syndrome after COVID-19 and sleeve gastrectomy:Contribution of neurochemical markers to early diagnosis

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Infectious Medicine 2022年第2期1卷 140-142页

作者： Souheil Zayet Hajer Zahra Nabil Belfeki Timothée Klopfenstein Beate Hagenkötter Infectious Diseases Department Nord Franche-ComtéHospitalFrance Diabetology Department Nord Franche-ComtéHospitalFrance Internal Medicine Department Groupe Hospitalier Sud Ile de FranceMelunFrance Neurology Department Nord Franche-ComtéHospitalFrance

Background:The coronavirus disease 2019(COVID-19)pandemic,caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),began in late *** recently,there have been sporadic case reports on devel-opment of Miller-Fisher Syndrome,a rare variant of Guillain-BarréSyndrome in COVID-19 *** report:We reported herein the case of a French young women presenting with ophtalmoplegia,cerebellar ataxia,and universal areflexia following a bariatric surgery(sleeve gastrectomy).A concomitant COVID-19 diagnosis was retained based on microbiological *** patient was successfully treated after high-dose intravenous thiamine,but areflexia *** COVID-19 related Miller-Fisher Syndrome was established on physical examination and confirmed by pathologic neurophysiological findings and elevated level of phosphorylated neurofilament heavy chain protein in cerebrospinal fluid ***:Guillain-BarréSyndrome and its variants after SARS-CoV-2 infection are extremely *** mea-surement of phosphorylated neurofilament heavy chain protein should be considered as an easy tool to detect an early affection of the peripheral nervous system.

关键词： COVID-19 Miller-fisher syndrome wernicke encephalopathy Bariatric surgery Phosphorylated neurofilament heavy chain Protein