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Wernicke encephalopathy without delirium in patients with cancer

Published online by Cambridge University Press:  03 May 2017

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
Yoshitada Taji
Affiliation:
Department of Laboratory 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
Daisuke Furuya
Affiliation:
Department of General Medicine, Saitama Medical University, Saitama International Medical Center, Saitama, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Graduate School of Medical Sciences, Nagoya City University, 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.

Abstract

Objective:

Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. Several reports of WE in cancer patients are known. WE is sometimes overlooked because most patients do not exhibit its typical symptoms (e.g., delirium, ataxia, ocular palsy). If delirium is not present, a diagnosis of WE is difficult because delirium is the hallmark symptom of WE.

Method:

Taken from a series on WE in cancer, we report two patients who developed WE without delirium during periodic psycho-oncology outpatient visits.

Results:

Case 1. A 61-year-old woman with non-Hodgkin lymphoma who was periodically attending a psycho-oncology outpatient clinic developed an unsteady gait. WE was suspected because she also developed appetite loss for two weeks, and we could find no other laboratory findings to explain her unsteady gait. Our diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after intravenous thiamine administration. Case 2. A 50-year-old woman with breast carcinoma with bone metastasis developed an unsteady gait. WE was suspected because she also developed loss of appetite for two weeks, and no other laboratory findings could explain her unsteady gait. The diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after administration of intravenous thiamine.

Significance of Results:

Our report emphasizes the importance of being aware of WE, even when patients do not present with delirium. The presence of loss of appetite for more than two weeks may be the key to a diagnosis of WE.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2017 

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