A Rare Complication Developing After Hematopoietic Stem Cell Transplantation: Wernicke's Encephalopathy.

Thiamine is a water-soluble vitamin. Thiamine deficiency can present as a central nervous system disorder known as Wernicke's encephalopathy, which classically manifests as confusion, ataxia, and ophthalmoplegia. Wernicke's encephalopathy has rarely been reported following hematopoietic stem cell transplantation. Herein, we report Wernicke's encephalopathy in a patient with acute myeloid leukemia who had been receiving prolonged total parenteral nutrition after haploidentical allogeneic hematopoietic stem cell transplantation. To the best of our knowledge, this is the first case reported from Turkey in the literature.

Is low blood magnesium level associated with hemodialysis headache?

OBJECTIVE: The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH). BACKGROUND: HDH has been recognized for many years, but the pathophysiology of this condition is not known. High arterial blood pressure, decreased serum osmolality, sodium washout, and high blood urea nitrogen level are reported risk factors for HDH. Low serum magnesium (Mg) level is known to cause some types of headache, including migraine (menstrual migraine in particular), tension-type headaches, and cluster and posttraumatic headaches. Low Mg has also been reported in HDH patients. METHODS: A total of 250 hemodialysis (HD) patients were questioned about problems with headache. Of these, 75 were diagnosed with HDH according to the revised International Headache Society criteria for 2003. Eighty age- and sex-matched HD patients without HDH were selected as a control group. For each HDH and control subject, arterial diastolic and systolic blood pressure, body weight, and serum levels of sodium, blood urea nitrogen, creatinine, and Mg were measured before and after one HD session. Urea reduction rate and ultrafiltration were determined. Serum levels of phosphorus, calcium, albumin, and parathormone were measured only before the session. Findings in the HDH and control group were statistically compared. RESULTS: As noted, 75 (30%) of the total 250 HD patients surveyed were diagnosed with HDH. The mean headache duration in this group was 5.17 +/- 5 hours. Vertex location, bilateral headache, dull nature, and moderate severity were the most prevalent features of HDH. There were no statistically significant differences between the HDH and control groups with respect to causes of end-stage renal disease. There were no significant differences between the HDH and control groups with respect to predialysis values for blood urea nitrogen, body weight, and arterial blood pressure (P > .05), and the same was true for comparisons of the postdialysis values for these parameters. The mean predialysis sodium level in the HDH group was higher than in the control group (P= .003). Both the mean predialysis and mean postdialysis Mg levels in the HDH group were significantly lower than the corresponding levels in the control group (P= .05 and P= .02, respectively). CONCLUSIONS: The results suggest that low blood Mg level and high blood sodium level may be risk factors for HDH. Magnesium supplementation may help patients with HDH whose serum Mg levels are found to be low.

Early diagnosis of diabetic neuropathy using double-shock stimulation of peripheral nerves.

OBJECTIVE: The purpose of this study was to determine the changes in the amplitudes of a sensory nerve action potential (NAP) to a conditioning stimulus given prior to a test stimulus at 2-8 ms intervals in healthy subjects and patients with diabetes mellitus with no clinical signs of neuropathy and normal nerve conduction velocities (NCVs), to be able to diagnose peripheral neuropathy at its very early stages. METHODS: NAPs in the superficial branch of the radial nerve were recorded in healthy subjects (28 women and 7 men) and type II diabetes patients without neuropathy (22 women and 12 men). Radial nerve was first stimulated with a single shock and then with double shocks at intervals of 2, 3, 4, 5, 6, 7, and 8 ms; NAP amplitudes and NAP1/NAP2 ratios were calculated in normals and diabetics. NCVs were within the normal ranges (>50 m/s) in all subjects. RESULTS: Of the independent variables--group (control, patient), sex (male, female), and hand (right, left)--only group significantly influenced NAP amplitude; mean NAP amplitude (single shock) was significantly lower in patients than controls. NAP1/NAP2 ratios were slightly below one (facilitation) in controls; it was above one at 1-8 ms stimulus intervals (inhibition) in diabetics, which was strongest at smallest intervals, gradually decreasing, and almost disappearing as the stimulus interval approached 8 ms. CONCLUSIONS: Using double-shock stimuli, an early diagnosis of peripheral neuropathy would be possible in diabetics without clinical signs of peripheral neuropathy and exhibiting no slowing in NCV.