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2014, Number 1

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Rev Med Inst Mex Seguro Soc 2014; 52 (1)

Wernicke’s encephalopathy and Caine criteria. Report of six cases

Kleinert-Altamirano API, Juárez-Jiménez H

Language: Spanish
References: 18
Page: 104-107
PDF size: 88.09 Kb.


ABSTRACT

Background: Wernicke’s encephalopathy is an acute and reversible neurologic disorder due to defi ciency of thiamin. Chronic alcoholism was the main cause in the past; currently, there are many other situations which favour this condition: prolonged intravenous feeding, hyperemesis gravidarum, anorexia nervosa, regional enteritis, malabsorption syndrome, hemodialysis, peritoneal dialysis, and abdominal surgery.
Clinical cases: we report six patients, three male and three female, who had in common total parenteral nutrition over two months, secondary to abdominal surgery complications and restriction to enteral nutrition. Clinical manifestations were drowsiness, psychomotor hyperactivity, ophthalmoplegia with bilateral abduction impairment, horizontal nystagmus; three patients with ataxia and appendicular dysmetria. Magnetic resonance imaging showed abnormal T2 hyperintensity of the superior colliculus, periaqueductal gray matter, mammillary bodies and dorsomedial nucleus of the thalamus, as well as abnormal T1 hyperintensity in both lenticular nucleus from manganese deposits due to total parenteral nutrition.
Conclusions: the classical triad is global confusional state, ocular abnormalities and ataxia. However, using the Caine criteria, the diagnosis could be faster in susceptible patients without previous alcoholism.


REFERENCES

  1. Murray RK, Mayes PA, Granner DK, Rodwell VW. Bioquímica de Harper. Décima cuarta edición. México: Manual Moderno; 1997.

  2. Castillo F, Cárdenas J. Vitaminas hidrosolubles y coenzimas. En: Herrera-Castillón E, editor. Bioquímica: aspectos estructurales y vías metabólicas. Vol. 1. Nueva York: McGraw-Hill-Interamericana; 1991.

  3. Wernicke C. Lehrbuch der gehirnkrankheiten für aerzte und studirende. Charleston, SC: Nabu Press; 2010.

  4. Hazell AS, Todd KG, Butterworth RF. Mechanisms of neuronal cell death in Wernicke’s encephalopathy. Metab Brain Dis. 1998;13(2):97-122.

  5. Navarro D, Zwingmann C, Hazell AS, Butterworth RF. Brain lactate synthesis in thiamine defi ciency: a reevaluation using 1H-13C nuclear magnetic resonance spectroscopy. J Neurosci Res. 2005;79(1-2):33-41.

  6. Matsushima K, MacManus JP, Hakim AM. Apoptosis is restricted to the thalamus in thiamine-defi cient rats. Neuroreport. 1997;8(4):867-70.

  7. Martin PR, Singleton CK, Hiller-Sturmhöfel S. The role of thiamine defi ciency in alcoholic brain disease. Alcohol Res Health. 2003;27(2):134-42.

  8. Hazell AS, Butterworth RF. Update of cell damage mechanisms in thiamine defi ciency: focus on oxidative stress, excitotoxicity and infl ammation. Alcohol Alcohol. 2009;44(2):141-7.

  9. Tanphaichitr V. Thiamin. En: Shils M, Shike M, Ross AC, Caballero B, Cousins RJ, editores. Modern nutrition in health and disease. Ninth edition. Philadelphia: Lippincott Williams & Wilkins; 1999.

  10. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442-55.

  11. Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology. 2007;68(11):807-11.

  12. Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report and review of the literature. Obstet Gynecol Surv. 2006;61(4):255-68.

  13. Ogershok PR, Rahman A, Nestor S, Brick J. Wernicke encephalopathy in nonalcoholic patients. Am J Med Sci. 2002;323(2):107-11.

  14. Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry. 1986;49(4):341-5.

  15. Caine D, Halliday GM, Kril JJ, Harper CG. Operational criteria for the classifi cation of chronic alcoholics: identifi cation of Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry. 1997;62(1):51-60.

  16. Zuccoli G, Pipitone N. Neuroimaging fi ndings in acute Wernicke’s encephalopathy: review of the literature. AJR Am J Roentgenol. 2009;192(2):501-8.

  17. Mirowitz SA, Westrich TJ, Hirsch JD. Hyperintense basal ganglia on T1-weighted MR images in patients receiving parenteral nutrition. Radiology. 1991;181(1):117-20.

  18. Thomson AD, Cook CC, Touquet R, Henry JA; Royal College of Physicians. The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the Accident and Emergency Department. Alcohol Alcohol. 2002;37(6):513-21.




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