Skip to main content Accessibility help
×
Home
Hostname: page-component-5bf98f6d76-zn7qb Total loading time: 9.689 Render date: 2021-04-21T11:16:28.339Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy

Published online by Cambridge University Press:  11 December 2015

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
Hiroaki Toyama
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
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
Keiichi Fujiwara
Affiliation:
Department of Gynecologic Oncology, Saitama Medical University Saitama International Medical Center, Saitama, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Corresponding
E-mail address:

Abstract

Objective:

Few reports of Wernicke encephalopathy in oncological settings have been published. Some cases of Wernicke encephalopathy are related to appetite loss; however, the degree to which loss of appetite leads to thiamine deficiency is not known.

Method:

A 63-year-old female with advanced cancer of the external genitalia was referred for psychiatric consultation because of disorientation, insomnia, and bizarre behaviors. Her symptoms fulfilled the diagnostic criteria for delirium. Routine laboratory examinations did not reveal the cause of the delirium. Thiamine deficiency was suspected because appetite loss had continued for 19 days since she had been admitted to hospital.

Results:

Intravenous administration of thiamine resulted in recovery from the delirium within three days. Serum thiamine level was found to be 16 ng/ml (normal range: 24–66 ng/ml). The clinical findings, the low level of thiamine in the serum, and the effective alleviation of delirious symptoms after thiamine administration fulfilled Francis's criteria for delirium induced by thiamine deficiency.

Significance of results:

Clinicians must be aware of the possibility of Wernicke encephalopathy in cancer patients, especially in those with loss of appetite for longer than 18 days. The degree of appetite loss in such patients might serve as a reference. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Type
Case Reports
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below.

References

Aksoy, M., Basu, T.K., Brient, J., et al. (1980). Thiamin status of patients treated with drug combinations containing 5-fluorouracil. European Journal of Cancer, 16(8), 10411045.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed (DSM–IV). Washington, DC: American Psychiatric Press.Google ScholarPubMed
Basu, T.K., Aksoy, M. & Dickerson, J.W. (1979). Effects of 5-fluorouracil on the thiamin status of adult female rats. Chemotherapy, 25(2), 7076.CrossRefGoogle ScholarPubMed
Blennow, G. (1975). Wernicke encephalopathy following prolonged artificial nutrition. American Journal of Diseases of Children, 129(12), 1456.Google ScholarPubMed
Breitbart, W., Gibson, C. & 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), 183194.CrossRefGoogle ScholarPubMed
Francis, J., Martin, D. & Kapoor, W.N. (1990). A prospective study of delirium in hospitalized elderly. The Journal of the American Medical Association, 263(8), 10971101.CrossRefGoogle ScholarPubMed
Handler, C.E. & Perkin, G.D. (1982). Anorexia nervosa and Wernicke's encephalopathy: An underdiagnosed association. Lancet, 2(8301), 771772.CrossRefGoogle Scholar
Harper, C., Gold, J., Rodriguez, M., et al. (1989). The prevalence of the Wernicke–Korsakoff syndrome in Sydney, Australia: A prospective necropsy study. Journal of Neurology, Neurosurgery, and Psychiatry, 52(2), 282285.CrossRefGoogle ScholarPubMed
Hollen, P.J., Gralla, R.J., Kris, M.G., 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), S51S58.CrossRefGoogle Scholar
Isenberg-Grzeda, E., Kutner, H.E. & Nicolson, S.E. (2012). Wernicke–Korsakoff syndrome: Underrecognized and undertreated. Psychosomatics, 53(6), 507516.CrossRefGoogle Scholar
Isenberg-Grzeda, E., Hsu, A.J., Hatzoglou, V., et al. (2014). Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliative & Supportive Care, October 23, 1–9 [Epub ahead of print].Google ScholarPubMed
MacLean, L.D., Rhode, B.M. & Shizgal, H.M. (1983). Nutrition following gastric operations for morbid obesity. Annals of Surgery, 198(3), 347355.CrossRefGoogle ScholarPubMed
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 and Symptom Management, 22(6), 9971006.CrossRefGoogle ScholarPubMed
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), 604608.CrossRefGoogle ScholarPubMed
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), 337340.CrossRefGoogle Scholar
Peters, W.A. III, Liu, P.Y., Barrett, R.J. II, et al. (2000). Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. Journal of Clinical Oncology, 18(8), 16061613.CrossRefGoogle ScholarPubMed
Sechi, G. & Serra, A. (2007). Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. The Lancet. Neurology, 6(5), 442455.CrossRefGoogle ScholarPubMed
Spruill, S.C. & Kuller, J.A. (2002). Hyperemesis gravidarum complicated by Wernicke's encephalopathy. Obstetrics and Gynecology, 99(5 Pt. 2), 875877.Google ScholarPubMed
van Zaanen, H.C. & van der Lelie, J. (1992). Thiamine deficiency in hematologic malignant tumors. Cancer, 69(7), 17101713.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Victor, M., Adams, R.D. & Collins, G.H. (1971). The Wernicke–Korsakoff syndrome: A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemporary Neurology Series, 7, 1206.Google ScholarPubMed
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), 333335.CrossRefGoogle Scholar
Yates, A.A., Schlicker, S.A. & Suitor, C.W. (1998). Dietary reference intakes: The new basis for recommendations for calcium and related nutrients, B vitamins, and choline. Journal of the American Dietetic Association, 98(6), 699706.CrossRefGoogle ScholarPubMed

Onishi supplementary material

Onishi supplementary material 1

PDF 31 KB

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 9
Total number of PDF views: 65 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 21st April 2021. This data will be updated every 24 hours.

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *