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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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