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Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: A case report and review of the literature

Published online by Cambridge University Press:  13 April 2006

HIDEKI ONISHI ,
YUKIO SUGIMASA ,
CHIAKI KAWANISHI  and
MASANARI ONOSE
HIDEKI ONISHI
Affiliation:
Department of Psychiatry, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
YUKIO SUGIMASA
Affiliation:
Department of Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
CHIAKI KAWANISHI
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
MASANARI ONOSE
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
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Abstract

Objective: Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients.

Methods: In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected.

Results and significance of the research: In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Keywords

Vitamin B1 deficiencyCancerDelirium
Type
CASE REPORTS
Information
Palliative & Supportive Care , Volume 3 , Issue 4 , December 2005 , pp. 337 - 340
Copyright
© 2005 Cambridge University Press

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