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1.
Rev Med Liege ; 74(5-6): 310-313, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31206272

RESUMO

Chronic alcohol consumption results in multiple peripheral and central nervous system dysfunctions. Some are due to the direct action of alcohol or its derivatives, others are induced by the vitamin deficiencies associated with alcoholism, others are eventually related to the failure of other vital organs, such as the liver. In this short review, we describe alcohol-induced neuropathy, Gayet-Wernicke syndrome, Korsakoff syndrome, alcoholic dementia, Marchiafava-Bignami syndrome, hepatic encephalopathy, alcoholic epilepsy and manifestations of alcohol withdrawal.


Assuntos
Alcoolismo , Demência , Encefalopatia Hepática , Encefalopatia de Wernicke , Alcoolismo/complicações , Alcoolismo/fisiopatologia , Demência/complicações , Encefalopatia Hepática/complicações , Humanos , Encefalopatia de Wernicke/complicações
2.
J Neurol ; 266(Suppl 1): 139-145, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31028542

RESUMO

Patients with Wernicke's encephalopathy (WE) often have unusual patterns of vertical nystagmus. Initially there is often a spontaneous upbeating nystagmus that may change to downbeat nystagmus with a change in the direction of gaze, convergence or with vestibular stimuli. Patients also often show a profound loss of the horizontal but not the vertical vestibulo-ocular reflex (VOR). Furthermore, the acute upbeat nystagmus may change to a chronic downbeat nystagmus. We present hypotheses for these features based on (1) the location of vertical gaze-holding networks near the area postrema of the dorsomedial medulla where the blood-brain barrier is located, which we suggest becomes compromised in WE, (2) the location of the vestibular nuclei in the brainstem, medially for the horizontal VOR, and laterally for the vertical VOR, (3) neuronal circuits differ in susceptibility to and in the ability to recover from thiamine deficiency, and (4) impaired processing of otolith information in WE, normally used to modulate translational vestibulo-ocular reflexes, leads to some of the characteristics of the spontaneous vertical nystagmus including the peculiar reversal in its direction with a change in gaze or convergence.


Assuntos
Nistagmo Patológico/complicações , Nistagmo Patológico/diagnóstico por imagem , Membrana dos Otólitos/fisiologia , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
Intern Med J ; 49(4): 536-539, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30957373

RESUMO

Wernicke encephalopathy (WE) is a neurological emergency that develops in the setting of thiamine deficiency, and is characterised by symptoms of confusion, ophthalmoplegia and gait ataxia. Less recognised signs and symptoms include vestibular dysfunction, hearing impairment, peripheral neuropathy, and in severe cases, coma. This case study describes a non-alcoholic patient, who presents with significant auditory and vestibular changes in addition to the classic symptoms of WE. This case report describes a non-alcoholic patient who developed deafness, severe horizontal canal paresis and symptoms of palinacousis in the setting of WE as a complication of a recent gastric sleeve operation.


Assuntos
Derivação Gástrica/efeitos adversos , Perda Auditiva/etiologia , Obesidade Mórbida/cirurgia , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Perda Auditiva/diagnóstico , Humanos , Imagem por Ressonância Magnética , Obesidade Mórbida/complicações , Complicações Pós-Operatórias , Encefalopatia de Wernicke/etiologia
4.
BMJ Case Rep ; 12(1)2019 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-30610031

RESUMO

A 56-year-old teetotaller man with hypertension and gout presented with a week duration of painless worsening diplopia on a background of loss of weight and appetite, generalised lethargy and weakness for 1 year. On examination, he was noted to be hypothermic and tachycardic with generalised muscle wasting. Proximal myopathy, lower limb fasciculations and areflexia, restricted bilateral eye abduction and nystagmus were observed. Blood investigations demonstrated compensated lactic acidosis, acute kidney injury and leucocytosis. A nerve conduction study showed severe length-dependent axonal sensorimotor polyneuropathy. This was a diagnostic dilemma until an MRI brain revealed symmetrical signal abnormality and enhancement in the periaqueductal area indicative of Wernicke's encephalopathy, caused by thiamine deficiency from poor nutrition. Beriberi, also caused by thiamine deficiency, accounted for his tachycardia, polyneuropathy, areflexia, hypothermia and biochemical abnormalities. Both beriberi and Wernicke's encephalopathy are medical emergencies, which were treated with intravenous thiamine to good effect.


Assuntos
Beriberi/complicações , Diplopia/diagnóstico , Debilidade Muscular/diagnóstico , Tiamina/uso terapêutico , Encefalopatia de Wernicke/diagnóstico por imagem , Beriberi/diagnóstico , Diagnóstico Diferencial , Diplopia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Doenças Raras , Tiamina/administração & dosagem , Deficiência de Tiamina/complicações , Resultado do Tratamento , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/uso terapêutico , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/patologia
5.
Nutr Neurosci ; 22(7): 528-530, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29272216

RESUMO

INTRODUCTION: Wernicke's encephalopathy (WE) is an acute neurologic syndrome resulting from a deficiency in thiamine, also known as Vitamin B1. Thiamine stores can be depleted rapidly in patients with severe hyperemesis. Treatment with thiamine typically results in complete resolution of the neurological abnormalities. CASE REPORT: A 15-year-old G2P0010 at 13.2 weeks gestation presented with altered mental status and transaminitis. She had a medical termination in her previous pregnancy following an admission for a similar clinical scenario. She was initially thought to have a postoperative surgical complication due to recent cholecystectomy, but further evaluation revealed thiamine depletion. Magnetic resonance imaging confirmed the diagnosis of WE. Repletion of thiamine and folic acid resulted in rapid clinical improvement. CONCLUSION: WE should be considered in the differential diagnosis of pregnant patients with hyperemesis and altered mental status. A prior history of WE increases the risk of recurrence during pregnancy. Severe hyperemesis during pregnancy increases the risk of thiamine deficiency and WE. Early thiamine supplementation may reduce the risk of WE in patients with a prior clinical history or in patients with severe hyperemesis gravidarum.


Assuntos
Complicações na Gravidez/patologia , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/patologia , Adolescente , Encéfalo , Feminino , Humanos , Hiperêmese Gravídica/complicações , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/psicologia , Encefalopatia de Wernicke/diagnóstico por imagem
6.
Rev. pesqui. cuid. fundam. (Online) ; 11(2, n. esp): 502-509, jan. 2019. il, tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-970107

RESUMO

Introduction: Wernicke-Korsakoff Syndrome (WKS) is one of the most serious consequences of alcohol abuse. The cognitive impact of the pathology is derived from alcoholic neurotoxicity and thiamine deficiency, which can progress to stupor, coma and death. Objective: Performing a case study regarding an alcoholic patient bearing the WKS, and also designing a nursing care plan. Methods: It is a case study with a qualitative approach that assesses an alcoholic patient bearing the WKS. The study was performed at the Hospital Universitário Oswaldo Cruz (HUOC) in Recife, Brazil, over the period from February to March 2016. Results: We were able to identify 14 nursing diagnoses, as follows: chronic confusion/memory deficit/disturbed thought processes/ impaired verbal communication; impaired walking/risk of tumble down; self-care deficit; nutrition smaller than the needs/fatigue; excessive fluid volume/impaired tissue integrity; bleeding risk; impaired skin integrity; ineffective tissue perfusion. Conclusion: The nursing professionals have singular importance with regards to both the execution of health education actions as well as the alcoholics' treatment, thus preventing the complications of the disease


Introdução: A síndrome de Wernicke-Korsakoff (SWK) é uma das mais graves consequências do abuso de álcool. O impacto cognitivo da patologia é derivado da neurotoxicidade alcóolica e deficiência de tiamina, podendo progredir para estupor, coma e morte. Objetivo: Realizar um estudo de caso de paciente alcoolista portador de SWK e construir um plano de assistência de enfermagem. Métodos: Estudo de caso com abordagem qualitativa. O estudo foi realizado no Hospital Universitário Oswaldo Cruz (HUOC), em Recife, Brasil, fevereiro a março de 2016. Resultados: Identificamos 14 diagnósticos de enfermagem: confusão crônica/memória prejudicada/ processos do pensamento perturbados/comunicação verbal prejudicada; deambulação prejudicada/risco de quedas; déficit no autocuidado; nutrição desequilibrada menor que as necessidades/fadiga; volume excessivo de líquido/integridade tissular prejudicada; risco de sangramento; integridade da pele prejudicada; perfusão tissular ineficaz. Conclusão: A enfermagem tem especial importância na execução das ações de educação em saúde e tratamento de alcoolistas prevenindo as complicações da doença


Introducción: El síndrome de Wernicke-Korsakoff (WKS) es una de las más graves consecuencias del abuso del alcohol. El impacto de trastorno cognitivo se deriva de la neurotoxicidad alcohólica y la deficiencia de tiamina, que puede progresar a estupor, coma y muerte. Objetivo: Realizar un estudio de caso de un paciente con SWK alcohólica y construir un plan de atención de enfermería. Métodos: Un estudio de caso con enfoque cualitativo. El estudio se realizó en el Hospital Universitario Oswaldo Cruz (HUOC) en Recife, Brasil, entre febrero y marzo de 2016 Resultados: Se identificaron 14 diagnósticos de enfermería: confusión crónica/deterioro de la memoria/ procesos de pensamiento perturbados/alteración de la comunicación verbal; alteración de la deambulación/riesgo de caídas; déficit de autocuidado; la nutrición desequilibrada menos necesita/fatiga; volumen excesivo de líquido/ la integridad del tejido deteriorado; riesgo de sangrado; alteración de la integridad de la piel; la perfusión tisular ineficaz. Conclusión: La enfermería tiene especial importancia en la implementación de las iniciativas de educación en la salud y el tratamiento de alcohólicos prevención de las complicaciones de la enfermedad


Assuntos
Humanos , Masculino , Feminino , Adulto , Encefalopatia de Wernicke/enfermagem , Síndrome de Korsakoff/enfermagem , Alcoolismo/complicações , Alcoolismo/enfermagem , Alcoólicos , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/prevenção & controle , Educação em Saúde , Síndrome de Korsakoff/complicações , Síndrome de Korsakoff/prevenção & controle
8.
Neurology ; 91(17): 790-796, 2018 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-30348852

RESUMO

OBJECTIVE: To explain (1) why an initial upbeat nystagmus (UBN) converts to a permanent downbeat nystagmus (DBN) in Wernicke encephalopathy (WE) and (2) why convergence and certain vestibular provocative maneuvers may transiently switch UBN to DBN. METHODS: Following a literature review and study of our 2 patients, we develop hypotheses for the unusual patterns of vertical nystagmus in WE. RESULTS: Our overarching hypothesis is that there is a selective vulnerability and a selective recovery from thiamine deficiency of neurons within brainstem gaze-holding networks. Furthermore, since the circuits affected in WE are commonly paraventricular, especially medially, just under the floor of the fourth ventricle where lie structures important for control of vertical gaze, we suggest the patterns of involvement in WE also reflect a breakdown in vulnerable areas of the blood-brain barrier. Many of the initial deficits of our patients improved over time, but their DBN did not. Irreversible changes in paramedian tract neurons, which project to the cerebellar flocculus, may be the cause. Here we suggest that conversion of UBN to permanent DBN points to thiamine deficiency and may argue for a chronic, nonprogressive DBN/truncal ataxia syndrome. Finally, we posit that the transient switch of UBN to DBN reflects abnormal processing of otolith information about linear acceleration, and often points to a diagnosis of WE. CONCLUSION: Recognizing the unusual patterns of transient switching and then permanent conversion of UBN to DBN in WE is vital since long-term disability from WE may be prevented by timely, parenteral high-dose thiamine.


Assuntos
Nistagmo Patológico/etiologia , Encefalopatia de Wernicke/complicações , Tronco Encefálico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Nistagmo Patológico/diagnóstico por imagem , Deficiência de Tiamina/complicações , Encefalopatia de Wernicke/diagnóstico por imagem
9.
BMJ Case Rep ; 20182018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30131406

RESUMO

Progressive supranuclear palsy (PSP) may be a risk factor for thiamine deficiency. The classic symptoms of PSP (postural instability, supranuclear vertical gaze palsy and dementia) overlap with the clinical triad of Wernicke's encephalopathy (cognitive impairment, gait problems and ocular abnormality). Therefore, superimposed thiamine deficiency in patients with PSP may aggravate the pre-existing symptoms of PSP. Here, we are reporting a 64-year-old woman having supranuclear ocular palsy, gait instability and dementia for the past 2-3 years. The patient fulfilled the diagnostic criteria of PSP. In parallel, she fulfilled the Caine's criteria of Wernicke's encephalopathy. Her serum thiamine level was low. Supplementation of thiamine led to marked improvement in the symptoms which had been present for many years. These symptoms were originally presumed to be due to PSP. This case highlights the needs to identify superimposed thiamine deficiency in patients with PSP.


Assuntos
Paralisia Supranuclear Progressiva/tratamento farmacológico , Deficiência de Tiamina/tratamento farmacológico , Tiamina/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Encefalopatia de Wernicke/tratamento farmacológico , Administração Intravenosa , Feminino , Humanos , Pessoa de Meia-Idade , Paralisia Supranuclear Progressiva/sangue , Paralisia Supranuclear Progressiva/complicações , Tiamina/sangue , Deficiência de Tiamina/etiologia , Encefalopatia de Wernicke/sangue , Encefalopatia de Wernicke/complicações
10.
Psychiatry Clin Neurosci ; 72(10): 774-779, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29984541

RESUMO

Anorexia nervosa (AN) is a common eating disorder that affects 2.9 million people worldwide. Not eating a balanced diet or fasting can cause neurological complications after severe vitamin B1 malnourishment, although the precise signs and symptoms of Wernicke's encephalopathy (WE) are not clear. Our aim was to review the signs and symptoms of WE in patients with AN. We searched MEDLINE, EMBASE, Scopus, and PiCarta on all case descriptions of WE following AN. All case descriptions of WE in AN, irrespective of language, were included. Twelve WE cases were reviewed, suggesting that WE following AN is still a relatively rare neuropsychiatric disorder. WE is characterized by a triad of: mental status change, ocular signs, and ataxia. In alcoholism, this triad is present in 16% of cases, but eight out of 12 AN cases presented themselves with a full triad of symptomatology. Importantly, patients often had a more complex triad than has been previously described, involving vertigo, diplopia, and the consequences of refeeding syndrome. The development of a full triad and additional symptomatology suggests a late recognition of signs and symptoms of WE in AN. A complicating factor is the overlap between symptoms of thiamine deficiency and the symptoms of WE. Specifically, patients who show rapid weight loss are vulnerable for the development of WE. Eating disorders, such as AN, can lead to WE. Prophylactic thiamine checks and treatment in patients with AN are relevant, and in case of suspicion of WE, adequate parenteral thiamine supplementation is necessary.


Assuntos
Anorexia Nervosa/complicações , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/prevenção & controle , Humanos , Encefalopatia de Wernicke/diagnóstico
11.
Palliat Support Care ; 16(6): 800-802, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29747720

RESUMO

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.ResultA 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 resultsThis 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.


Assuntos
Neoplasias Pulmonares/complicações , Agitação Psicomotora/etiologia , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/etiologia , Delírio/psicologia , Feminino , Humanos , Neoplasias Pulmonares/fisiopatologia , Pessoa de Meia-Idade , Agitação Psicomotora/fisiopatologia , Tiamina/análise , Tiamina/sangue , Tiamina/uso terapêutico , Deficiência de Tiamina/tratamento farmacológico , Encefalopatia de Wernicke/fisiopatologia
13.
Rinsho Shinkeigaku ; 58(2): 100-104, 2018 Feb 28.
Artigo em Japonês | MEDLINE | ID: mdl-29386493

RESUMO

A 61-year-old man was admitted to our institution with progressive hypoacusia, double vision, and lightheadedness. Neurological examination on day 6 of his illness showed severe hypoacusia, mild confusion, ocular motility disorder, truncal ataxia and absence of a deep tendon reflex. MRI fluid-attenuated inversion recovery imaging revealed symmetrical high intensities in the tectum of the midbrain, involving the bilateral inferior colliculi and the bilateral medial thalami, which suggested Wernicke encephalopathy (WE). Thiamine was administered immediately after completion of the MRI, and the patients' hearing and other abnormal neurologic signs improved rapidly within a few days, except for the absence of the deep tendon reflex. Whole blood examination at admission revealed very low levels of vitamin B1. The patient was discharged on day 19, and MRI on day 39 showed the disappearance of the abnormal high intensities involving the bilateral inferior colliculi. The present case indicates that hypoacusia and abnormal MRI signal due to WE might be normalized by administration of thiamine a few days after the onset of symptoms.


Assuntos
Perda Auditiva/tratamento farmacológico , Perda Auditiva/etiologia , Colículos Inferiores/diagnóstico por imagem , Imagem por Ressonância Magnética , Tiamina/administração & dosagem , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Biomarcadores/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Tiamina/sangue , Resultado do Tratamento , Encefalopatia de Wernicke/complicações
14.
Psychosomatics ; 59(4): 379-387, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29482863

RESUMO

BACKGROUND: Wernicke encephalopathy is a common neuropsychiatric syndrome due to thiamine deficiency. There is no consensus regarding thiamine dosing when Wernicke encephalopathy is suspected. A longstanding dosing strategy for Wernicke encephalopathy is 100mg daily, yet updated clinical guidelines suggest using high-dose intravenous (HDIV) thiamine. OBJECTIVE: To describe thiamine prescribing practices at a large, public academic hospital and investigate clinical characteristics and outcomes associated with HDIV thiamine in patients with encephalopathy who received IV thiamine. METHODS: Electronic medical records of hospitalized patients who received thiamine between 4/4/2014 and 11/1/2015 were reviewed. Chi-square tests, Wilcoxon Rank Sum tests, and logistic regression were used to compare clinical variables in patients with encephalopathy who received HDIV thiamine (≥ 200mg twice daily) vs lower doses of IV thiamine. RESULTS: Among the total of 5236 thiamine orders, 29% (n = 1531) were IV; 10% (n = 150) of IV orders met HDIV criteria. In patients with encephalopathy who received IV thiamine (n = 432), HDIV thiamine was administered to 20% (n = 86) and only 2.1% (n = 9) received dosing consistent with Royal College of Physicians guidelines. In bivariable analyses, HDIV thiamine was associated with surgical services (p = 0.001), psychiatric consultation (p < 0.001), and decreased mortality (p = 0.004). In multivariable models, the association between HDIV thiamine and decreased in-hospital mortality did not meet statistical significance (p = 0.061). CONCLUSIONS: In a large, public academic hospital, guideline-concordant thiamine supplementation is rare and HDIV thiamine is infrequently prescribed to patients with encephalopathy. Further studies are needed to confirm the possible benefits of HDIV thiamine for patients with suspected thiamine-deficient encephalopathy.


Assuntos
Deficiência de Tiamina/complicações , Deficiência de Tiamina/tratamento farmacológico , Tiamina/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/tratamento farmacológico , Administração Intravenosa , Estudos de Coortes , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tiamina/administração & dosagem , Resultado do Tratamento , Complexo Vitamínico B/administração & dosagem
15.
Eur J Clin Nutr ; 72(1): 168-169, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28901332

RESUMO

A diagnosis of Wernicke's encephalopathy (WE) is difficult. Transient hypotension has been reported as a rare complication of WE. We herein report a case of prolonged hypotension and dysuautonomia associated with WE in a 69-year-old man with underlying alcohol abuse. Without apparent etiology of shock, this patient remained hypotensive for 9 days, requiring a vasopressor, despite daily administration of thiamine 600 mg. Fluctuation of blood pressure caused by postural change and bradycardia in the presence of shock indicated that this patient had dysautonomia. This case hereby proposes a possible association between hypotension, dysautonomia and Wernicke's encephalopathy.


Assuntos
Hipotensão/complicações , Encefalopatia de Wernicke/complicações , Idoso , Alcoolismo/complicações , Doenças do Sistema Nervoso Autônomo/complicações , Bradicardia/complicações , Bradicardia/tratamento farmacológico , Dobutamina/administração & dosagem , Humanos , Hipotensão/tratamento farmacológico , Japão , Masculino , Norepinefrina/administração & dosagem , Choque/complicações , Tiamina/administração & dosagem , Deficiência de Tiamina/complicações , Deficiência de Tiamina/tratamento farmacológico , Encefalopatia de Wernicke/diagnóstico
16.
Artigo em Inglês | MEDLINE | ID: mdl-29286589

RESUMO

Objective: Wernicke's encephalopathy is caused by thiamine deficiency and occurs predominantly in alcohol-dependent individuals but also develops in those who are malnourished due to other reasons including medical and psychiatric disorders. This study examined the frequency rate and management of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients admitted to a psychiatric hospital. Methods: Data were retrospectively collected from electronic medical records of psychiatric inpatients admitted to a teaching hospital located in Texas between September 2013 and March 2014. The diagnostic criteria of Caine and colleagues and thiamine dosing strategies were used to identify cases of suboptimal management. Results: A total of 486 charts were reviewed. Nine patients (1.85%) had clinical signs of Wernicke's encephalopathy, and 36 (7%, n = 486) were at a high risk for developing the disorder. None of these patients received adequate doses of parenteral thiamine, and of those who were prescribed thiamine, the majority, including high-risk patients, were prescribed oral thiamine at the traditional dose of 100 mg/d. Conclusions: The findings suggest that Wernicke's encephalopathy is underdiagnosed and undertreated. Our study also highlights the need for clarifying diagnostic criteria, identifying the risk factors for thiamine deficiency, and improving awareness among physicians about diagnosis, prevention, and adequate treatment of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients.


Assuntos
Pessoas Mentalmente Doentes/estatística & dados numéricos , Encefalopatia de Wernicke/epidemiologia , Adulto , Alcoolismo/complicações , Alcoolismo/epidemiologia , Gerenciamento Clínico , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/terapia
17.
Gastroenterol. hepatol. (Ed. impr.) ; 40(10): 709-717, dic. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-169219

RESUMO

En este artículo se revisan las distintas manifestaciones neurológicas del consumo excesivo de alcohol, que pueden ser agudas o crónicas y afectar al sistema nervioso central o periférico. El mecanismo por el cual se producen varía de un grupo de trastornos a otro. Destacan factores nutricionales, efectos tóxicos del alcohol, factores metabólicos e incluso inmunológicos. Estas manifestaciones pueden conllevar una gran morbilidad y un aumento significativo de la mortalidad, por lo que es importante reconocerlas y tratarlas precozmente (AU)


This article reviews the different acute and chronic neurological manifestations of excessive alcohol consumption that affect the central or peripheral nervous system. Several mechanisms can be implicated depending on the disorder, ranging from nutritional factors, alcohol-related toxicity, metabolic changes and immune-mediated mechanisms. Recognition and early treatment of these manifestations is essential given their association with high morbidity and significantly increased mortality (AU)


Assuntos
Humanos , Alcoolismo/complicações , Alcoolismo/diagnóstico por imagem , Doenças do Sistema Nervoso/complicações , Encefalopatia Hepática/complicações , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/diagnóstico por imagem , Tiamina/uso terapêutico , Indicadores de Morbimortalidade , Sistema Nervoso Central , Síndrome de Korsakoff/complicações , Doença de Marchiafava-Bignami/complicações , Doenças Cerebelares/complicações , Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/complicações
19.
Metab Brain Dis ; 32(6): 2085-2093, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28875427

RESUMO

Wernicke encephalopathy (WE) is characterized by eye signs, cerebellar dysfunction, and confusion. Epileptic seizures are rare in nonalcoholic WE. We reviewed the clinical, laboratory, radiological, and prognostic characteristics of nonalcoholic WE accompanied by epileptic seizures. We reported 1 case and searched similar cases using PubMed, WoK, Ovid, and Embase. WE was diagnosed according to dietary deficiencies, clinical symptoms and brain magnetic resonance imaging (MRI). We reviewed 13 patients (median age, 27 years; 5 men) with clear histories of thiamine deficiency and symptoms of typical WE. The type of epileptic seizures reported in the 13 cases reviewed was generically reported as seizures or convulsions in 4 patients; 7 patients had generalized tonic-clonic seizures, 1 partial seizure, and 1 generalized convulsive status epileptics. Two patients had epileptic seizures as the first symptom of WE. Laboratory tests mainly indicated metabolic acidosis and electrolyte disturbances. Electroencephalography may present as normal patterns, increased slow waves or epileptic discharge. Six patients had cortical lesions on brain MRI. These lesions were usually diffuse and band-like, and sometimes involved all lobes either symmetrically or asymmetrically, with the frontal lobe as the most susceptible area. All cortical lesions were accompanied by non-cortical lesions typical of WE. Brain MRI abnormalities, after thiamine treatment, mostly disappeared on follow-up MRIs. The patients had good prognoses. Only 1 patient had repeated seizures, and there were no comas or deaths. Patients with nonalcoholic WE accompanied by seizures are young and generally have good prognoses. Most patients experienced generalized convulsive seizures, which may have been related to abnormal cerebral cortical metabolism due to subacute thiamine deficiency.


Assuntos
Convulsões/complicações , Deficiência de Tiamina/complicações , Encefalopatia de Wernicke/complicações , Adolescente , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Convulsões/diagnóstico por imagem , Convulsões/tratamento farmacológico , Tiamina/uso terapêutico , Deficiência de Tiamina/diagnóstico por imagem , Deficiência de Tiamina/tratamento farmacológico , Resultado do Tratamento , Encefalopatia de Wernicke/diagnóstico por imagem , Encefalopatia de Wernicke/tratamento farmacológico , Adulto Jovem
20.
BMJ Case Rep ; 20172017 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-28765488

RESUMO

Wernicke's encephalopathy is a rare neurological disorder caused by thiamine deficiency, characterised by ocular motor dysfunction, ataxia and impairment in consciousness. It predominantly affects brain regions with a high metabolic rate such as mammillary bodies, medial thalamic nuclei, the tectal region and the cerebellum. Although chronic alcoholism is the most common cause of Wernicke's encephalopathy, various other conditions not related to alcohol consumption such as bariatric surgery, acute pancreatitis, hyperemesis gravidarum, prolonged fasting and gastrointestinal surgery have been implicated in its aetiology. We report the case of a patient who underwent surgery for liver abscess and subsequently developed Wernicke's encephalopathy; he showed a positive response to thiamine supplementation. This is the first report describing liver abscess as the cause of Wernicke's encephalopathy.


Assuntos
Encéfalo/patologia , Abscesso Hepático/cirurgia , Tiamina/uso terapêutico , Encefalopatia de Wernicke/diagnóstico , Administração Intravenosa , Encéfalo/metabolismo , Diagnóstico Diferencial , Humanos , Abscesso Hepático/complicações , Masculino , Pessoa de Meia-Idade , Tiamina/administração & dosagem , Deficiência de Tiamina/complicações , Resultado do Tratamento , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/tratamento farmacológico
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