Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-21T01:53:20.990Z Has data issue: false hasContentIssue false
  • English
  • Français

Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic

Published online by Cambridge University Press:  26 February 2018

Hideki Onishi ,
Mayumi Ishida ,
Iori Tanahashi ,
Takao Takahashi ,
Kenji Ikebuchi ,
Yoshitada Taji ,
Hisashi Kato  and
Tatsuo Akechi
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Iori Tanahashi
Affiliation:
Department of Psycho-oncology, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Takao Takahashi
Affiliation:
Department of Palliative Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Kenji Ikebuchi
Affiliation:
Department of Laboratory Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Yoshitada Taji
Affiliation:
Department of Laboratory Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Hisashi Kato
Affiliation:
Department of Palliative Medicine, Saitama Medical University Saitama International Medical Center, Saitama, Japan Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University Saitama International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Wernicke's encephalopathy (WE) is a neuropsychiatric disorder caused by a thiamine deficiency. Although WE has been recognized in cancer patients, it can be overlooked because many patients do not exhibit symptoms that are typical of WE, such as delirium, ataxia, or ocular palsy. Furthermore, outpatients with WE who intermittently present at psycho-oncology clinics have not been described as far as we can ascertain.

Method

This report describes two patients who did not exhibit the complete classic triad of symptoms among a series with cancer and WE, and who attended a psycho-oncology outpatient clinic.

Result

Case 1, a 76-year-old woman with pancreatic cancer and liver metastasis, periodically attended a psycho-oncology outpatient clinic. She presented with delirium and ataxia as well as appetite loss that had persisted for 8 weeks. We suspected WE, which was confirmed by low serum thiamine levels and the disappearance of delirium after thiamine administration. Case 2, a 79-year-old man with advanced stomach cancer, was referred to a psycho-oncology outpatient clinic with depression that had persisted for about 1 month. He also had appetite loss that had persisted for several weeks. He became delirious during the first visit to the outpatient clinic. Our initial suspicion of WE was confirmed by low serum thiamine levels and the disappearance of delirium after thiamine administration. The key indicator of a diagnosis of WE in both patients was appetite loss.

Significance of results

This report emphasizes awareness of WE in the outpatient setting, even when patients do not exhibit the classical triad of WE. Appetite loss might be the key to a diagnosis of WE in the absence of other causes of delirium.

Type
Case Report
Information
Palliative & Supportive Care , Volume 16 , Issue 5 , October 2018 , pp. 633 - 636
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akechi, T, Nakano, T, Okamura, H, et al. (2001) Psychiatric disorders in cancer patients: Descriptive analysis of 1721 psychiatric referrals at two Japanese cancer center hospitals. Japanese Journal of Clinical Oncology (Tokyo) 31(5), 188–194.Google Scholar
Aksoy, M, Basu, TK, Brient, J, et al. (1980) Thiamin status of patients treated with drug combinations containing 5-fluorouracil. European Journal of Cancer 16(8), 1041–1045.Google Scholar
Antunez, E, Estruch, R, Cardenal, C, et al. (1998) Usefulness of CT and MR imaging in the diagnosis of acute Wernicke's encephalopathy. AJR American Journal of Roentgenology 171(4), 1131–1137.Google Scholar
Basu, TK, Aksoy, M, and Dickerson, JW (1979) Effects of 5-fluorouracil on the thiamin status of adult female rats. Chemotherapy 25(2), 70–76.Google Scholar
Breitbart, W, Gibson, C, and Tremblay, A (2002) The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics 43(3), 183–194.Google Scholar
Caine, D, Halliday, GM, Kril, JJ, et al. (1997) Operational criteria for the classification of chronic alcoholics: Identification of Wernicke's encephalopathy. Journal of Neurology, Neurosurgery and Psychiatry 62(1), 51–60.Google Scholar
Galvin, R, Brathen, G, Ivashynka, A, et al. (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European Journal of Neurology 17(12), 1408–1418.Google Scholar
Harper, C (1979) Wernicke's encephalopathy: A more common disease than realised. A neuropathological study of 51 cases. Journal of Neurology, Neurosurgery and Psychiatry 42(3), 226–231.Google Scholar
Harper, CG, Giles, M, and Finlay-Jones, R (1986) Clinical signs in the Wernicke-Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy. Journal of Neurology, Neurosurgery and Psychiatry 49(4), 341–345.Google Scholar
Hollen, PJ, Gralla, RJ, Kris, MG, et al. (1993) Quality of life assessment in individuals with lung cancer: Testing the Lung Cancer Symptom Scale (LCSS). European Journal of Cancer 29A (Suppl 1), S51–S58.Google Scholar
Hui, D, dos Santos, R, Reddy, S, et al. (2015) Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study. Palliative Medicine 29(9), 826–833.Google Scholar
Inouye, SK, Marcantonio, ER, Metzger, ED (2014) Doing damage in delirium: The hazards of antipsychotic treatment in elderly persons. Lancet Psychiatry 1(4), 312–315.Google Scholar
Isenberg-Grzeda, E, Alici, Y, Hatzoglou, V, et al. (2016) Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff syndrome) among inpatients with cancer: A series of 18 cases. Psychosomatics 57(1), 71–81.Google Scholar
Isenberg-Grzeda, E, Chabon, B, and Nicolson, SE (2014a) Prescribing thiamine to inpatients with alcohol use disorders: How well are we doing? Journal of Addiction Medicine 8(1), 1–5.Google Scholar
Isenberg-Grzeda, E, Hsu, AJ, Hatzoglou, V, et al. (2014b) Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliative & Supportive Care 13(5), 1–9.Google Scholar
Isenberg-Grzeda, E, Kutner, HE, and Nicolson, SE (2012) Wernicke-Korsakoff-syndrome: Under-recognized and under-treated. Psychosomatics 53(6), 507–516.Google Scholar
Kissane, DW and Smith, GC (1996) Consultation-liaison psychiatry in an Australian oncology unit. Australian and New Zealand Journal of Medicine 30(3), 397–404.Google Scholar
MacLean, LD, Rhode, BM, and Shizgal, HM (1983) Nutrition following gastric operations for morbid obesity. Annals of Surgery 198(3), 347–355.Google Scholar
Massie, MJ and Holland, JC (1987). Consultation and liaison issues in cancer care. Psychiatric Medicine 5(4), 343–359.Google Scholar
Meagher, DJ (2001) Delirium: Optimising management. BMJ 322(7279), 144–149.Google Scholar
Morita, T, Tei, Y, Tsunoda, J, et al. (2001) Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. Journal of Pain Symptom Management 22(6), 997–1006.Google Scholar
Ogershok, PR, Rahman, A, Nestor, S, et al. (2002) Wernicke encephalopathy in nonalcoholic patients. American Journal of the Medical Sciences 323(2), 107–111.Google Scholar
Onishi, H, Ishida, M, Toyama, H, et al. (2015) Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. Palliative & Supportive Care 14(3), 1–5.Google Scholar
Onishi, H, Kawanishi, C, Onose, M, et al. (2004) Successful treatment of Wernicke encephalopathy in terminally ill cancer patients: Report of 3 cases and review of the literature. Supportive Care in Cancer 12(8), 604–608.Google Scholar
Onishi, H, Sugimasa, Y, Kawanishi, C, et al. (2005) 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. Palliative & Supportive Care 3(4), 337–340.Google Scholar
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurology 6(5), 442–455.Google Scholar
Tada, Y, Matsubara, M, Kawada, S, et al. (2012) Psychiatric disorders in cancer patients at a university hospital in Japan: Descriptive analysis of 765 psychiatric referrals. Japanese Journal of Clinical Oncology 42(3), 183–188.Google Scholar
Victor, M, Adams, RD, and Collins, GH (1971) The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemporary Neurology Services 7, 1–206.Google Scholar
Wilkinson, TJ, Hanger, HC, Elmslie, J, et al. (1997) The response to treatment of subclinical thiamine deficiency in the elderly. Amercian Journal of Clinical Nutrition 66(4), 925–928.Google Scholar
Yae, S, Okuno, S, Onishi, H, et al. (2005) Development of Wernicke encephalopathy in a terminally ill cancer patient consuming an adequate diet: A case report and review of the literature. Palliative & Supportive Care 3(4), 333–335.Google Scholar