Wernicke’s encephalopathy in a malnourished surgical patient: a difficult diagnosis

BMC Research Notes

Massimo Girardis²  Nicola Cautero¹  Alessandra Todeschini³  Marcella Malagoli³  Arianna Gaspari²  Cinzia Bonvecchio²  Stefano Busani² 

[1] Centro Trapianti di Fegato e Multiviscerale, Policlinico di Modena, Modena, Italy;Cattedra di Anestesia e Rianimazione, Policlinico di Modena, Università di Modena e Reggio Emilia, Modena, Italy;Servizio di Neuroradiologia, N.O.C.S.A.E., Modena, Italy

关键词: Cerebral bleeding;    Septic shock;    MRI;    Wernicke’s encephalopathy;   

Others  :  1127267
DOI  :  10.1186/1756-0500-7-718

 received in 2014-04-11, accepted in 2014-10-08,  发布年份 2014

【 摘 要 】

Background

Wernicke’s encephalopathy is an acute neurological disorder resulting from thiamine deficiency mainly related to alcohol abuse. Severe thiamine deficiency is an emerging problem in non-alcoholic patients and it may develop in postoperative surgical patients with risk factors.

Case presentation

We reported a case of a 46 years old woman who underwent, one year before, to cephalic duodenopancreatectomy complicated with prolonged recurrent vomiting. She underwent to a second surgical operation for intestinal sub-occlusion and postoperatively she developed septic shock and hemorrhagic Wernicke’s disease. After ICU admission, because of neurological deterioration, she underwent CT scan and MRI that highlighted a strong suspicion for Wernicke’s disease. We treated her with an initially wrong low dose of thiamine, then after MRI we increased the dosage with a neurological status improvement. Despite therapeutic efforts used to control septic shock and thrombocytopenia, she died on the 21^st day after surgery because of massive cerebral bleeding and unresponsive cerebral edema.

Conclusion

Early detection of subclinical thiamine deficiency is a difficult task, as symptoms may be nonspecific. Wernicke’s disease remains a clinical diagnosis because there are no specific diagnostic abnormalities revealed in cerebrospinal fluid, electroencephalogram or evoked potentials. About this, the best aid for a correct diagnosis is the clinical suspicion and clinicians should consider the disorder in any patients with unbalanced nutrition, increased metabolism or impaired food absorption. A hallmark of our case was the brain hemorrhage in the typical areas of the Wernicke’s disease, maybe triggered by the thrombocytopenia secondary to sepsis. It might be a good clinical practice administer thiamine to all patients presenting with coma or stupor and risk factors related with thiamine deficiency. Any therapeutic delay may result in permanent neurological damage or death.

【 授权许可】

   
2014 Busani et al.; licensee BioMed Central Ltd.

【 图 表 】

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