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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*
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: honishi@saitama-med.ac.jp

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
Copyright
Copyright © Cambridge University Press 2018 

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