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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 ,
Mayumi Ishida ,
Hiroaki Toyama ,
Iori Tanahashi ,
Kenji Ikebuchi ,
Yoshitada Taji ,
Keiichi Fujiwara  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
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
*
Address correspondence and reprint requests to Hideki Onishi, Department of Psycho-Oncology, Saitama Medical University Saitama International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan. E-mail: honishi@saitama-med.ac.jp.
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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.

Keywords

Thiamine deficiencyCancerDeliriumWernicke encephalopathy
Type
Case Reports
Information
Palliative & Supportive Care , Volume 14 , Issue 3 , June 2016 , pp. 302 - 306
Copyright
Copyright © Cambridge University Press 2015 

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References

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), 1041–1045.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed (DSM–IV). Washington, DC: American Psychiatric Press.Google Scholar
Basu, T.K., Aksoy, M. & Dickerson, J.W. (1979). Effects of 5-fluorouracil on the thiamin status of adult female rats. Chemotherapy, 25(2), 70–76.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), 183–194.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), 1097–1101.CrossRefGoogle ScholarPubMed
Handler, C.E. & Perkin, G.D. (1982). Anorexia nervosa and Wernicke's encephalopathy: An underdiagnosed association. Lancet, 2(8301), 771–772.CrossRefGoogle ScholarPubMed
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), 282–285.CrossRefGoogle Scholar
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), S51–S58.CrossRefGoogle Scholar
Isenberg-Grzeda, E., Kutner, H.E. & Nicolson, S.E. (2012). Wernicke–Korsakoff syndrome: Underrecognized and undertreated. Psychosomatics, 53(6), 507–516.CrossRefGoogle ScholarPubMed
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 Scholar
MacLean, L.D., Rhode, B.M. & Shizgal, H.M. (1983). Nutrition following gastric operations for morbid obesity. Annals of Surgery, 198(3), 347–355.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), 997–1006.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), 604–608.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), 337–340.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), 1606–1613.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), 442–455.CrossRefGoogle ScholarPubMed
Spruill, S.C. & Kuller, J.A. (2002). Hyperemesis gravidarum complicated by Wernicke's encephalopathy. Obstetrics and Gynecology, 99(5 Pt. 2), 875–877.Google ScholarPubMed
van Zaanen, H.C. & van der Lelie, J. (1992). Thiamine deficiency in hematologic malignant tumors. Cancer, 69(7), 1710–1713.3.0.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, 1–206.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), 333–335.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), 699–706.CrossRefGoogle ScholarPubMed
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