Wernicke Encephalopathy in a Patient with Long-Standing Vomiting after Pancreatoduodenectomy.
- Author:
Woo Young PARK
1
;
Sung Wan KIM
;
Sam Yeon LEE
;
Il Seon SHIN
;
Jae Min KIM
;
Kee Hyung PARK
;
Su Jin YANG
;
Jin Sang YOON
Author Information
1. Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea. syoon@chonnam.ac.kr
- Publication Type:Case Report
- Keywords:
Wernicke encephalopathy;
Vomiting;
TPN;
Thiamine;
Mirtazapine
- MeSH:
Ataxia;
Consciousness;
Female;
Head and Neck Neoplasms;
Humans;
Mamillary Bodies;
Middle Aged;
Nausea;
Nervous System Diseases;
Neurologic Manifestations;
Ophthalmoplegia;
Pancreaticoduodenectomy*;
Parenteral Nutrition, Total;
Periaqueductal Gray;
Thalamus;
Thiamine;
Vitamins;
Vomiting*;
Wernicke Encephalopathy*
- From:Journal of Korean Neuropsychiatric Association
2007;46(3):267-270
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Wernicke encephalopathy is an acute neurologic disorder attributable to thiamine (vitamin B1) deficiency. We report the case of a 61-year-old female patient who presented Wernicke encephalopathy after surgery for pancreatic head cancer. From the ninth postoperative day, she had suffered from nausea and vomiting and had difficulties ingesting food, she was given total parenteral nutrition (TPN), but lacked adequate vitamin (thiamine) supplementation. After 28 days, she developed ataxia, ophthalmoplegia, and mental confusion. The magnetic resonance image showed pathologic changes in the medial thalamus, periaqueductal gray matter, medulla and mamillary bodies. The blood level of thiamine was very low. After intravenous and oral supplementation of thiamine (200 mg/day), consciousness was soon normalized and neurologic symptoms have gradually been improving. Nausea and vomiting disappeared after administration of a low dose of mirtazapine (7.5 mg/day). We emphasize the importance of thiamine supplementation to the patients who suffer from vomiting which hinders them from taking food and who require prolonged TPN.
