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Wernicke encephalopathy without delirium that appeared as agitation in a patient with lung cancer

Published online by Cambridge University Press:  11 May 2018

Hideki Onishi ,
Mayumi Ishida ,
Takao Takahashi ,
Yoshitada Taji ,
Kenji Ikebuchi ,
Daisuke Furuya ,
Nozomu Uchida  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
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
Nozomu Uchida
Affiliation:
Department of General 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
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Abstract

Objective

Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency, and is sometimes overlooked because of the diversity of clinical symptoms.

Method

From a series of WE patients with cancer, we report a lung cancer patient who developed WE, the main symptom of which was agitation.

Result

A 50-year-old woman with lung cancer was referred to our psycho-oncology clinic because of agitation lasting for three days. No laboratory findings or drugs explaining her agitation were identified. Although the patient did not develop delirium, ophthalmoplegia, or ataxia, WE was suspected because she experienced a loss of appetite loss lasting 5 weeks. This diagnosis was supported by abnormal serum thiamine and disappearance of agitation one hour after intravenous thiamine administration.

Significance of results

This report emphasizes the clinical diversity of WE and indicates the limits of the ability to diagnose WE from typical clinical symptoms. The presence of a loss of appetite for more than two weeks may be the key to the accurate diagnosis of WE.

Keywords

Wernicke encephalopathythiamine deficiencyagitationdelirium
Type
Case Report
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 800 - 802
Copyright
Copyright © Cambridge University Press 2018 

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