Top

Published in:

01-10-2017 | Original Article

Non-alcoholic Wernicke’s encephalopathy with cortical involvement and polyneuropathy following gastrectomy

Authors: Wei-Chia Tsao, Long-Sun Ro, Chiung-Mei Chen, Hong-Chiu Chang, Hung-Chou Kuo

Published in: Metabolic Brain Disease | Issue 5/2017

Abstract

In this study, we present the clinical manifestations, brain magnetic resonance imaging (MRI) and concurrent polyneuropathies in two patients with non-alcoholic Wernicke’s encephalopathy (WE) after gastrojejunostomy (Billroth II) anastomosis procedures. These patients developed sub-acute onset of disorientation and disturbance of consciousness following several weeks of poor intake. Peripheral neuropathy of varying severity was noted before and after the onset of WE. Brain MRI of the patients showed cerebellar vermis and symmetric cortical abnormalities in addition to typical WE changes. Electrophysiological studies demonstrated axonal sensorimotor polyneuropathy. Prompt thiamine supplement therapy was initiated and both patients gradually recovered, however mild amnesia was still noted 6 months later. We reviewed non- alcoholic WE with atypical cortical abnormalities in English language literatures and identified 29 more cases. Eight out of 31 (25.8%) patients died during follow-up. Nine patients with gait disturbance or motor paresis had showed hyporeflexia in neurological examinations. In addition to classic triad, seizure was recorded in seven patients. Dietary deprivation is a risk factor for non-alcoholic WE among elderly patients receiving gastrointestinal surgery. The prognosis is good after thiamine supplement therapy. Recognizing the MRI features and predisposing factors in patients who have undergone gastrectomy can aid in the diagnosis and management.

Aasheim ET (2008) Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg 248:714–720. doi:10.1097/SLA.0b013e3181884308 PubMed

Antunez E, Estruch R, Cardenal C, Nicolas JM, Fernandez-Sola J, Urbano-Marquez A (1998) Usefulness of CT and MR imaging in the diagnosis of acute Wernicke's encephalopathy. AJR Am J Roentgenol 171:1131–1137. doi:10.2214/ajr.171.4.9763009 CrossRefPubMed

Bakker SJ, Leunissen KM (1995) Hypothesis on cellular ATP depletion and adenosine release as causes of heart failure and vasodilatation in cardiovascular beriberi. Med Hypotheses 45:265–267CrossRefPubMed

Bonucchi J, Hassan I, Policeni B, Kaboli P (2008) Thyrotoxicosis associated Wernicke's encephalopathy. J Gen Intern Med 23:106–109. doi:10.1007/s11606-007-0438-3 CrossRefPubMed

Chen MH, Lee JT, Peng GS, Sung YF (2015) Non-alcoholic Wernicke's encephalopathy as a cause of profound shock after abdominal surgery. QJM 108:661–663. doi:10.1093/qjmed/hct044 CrossRefPubMed

Cirignotta F, Manconi M, Mondini S, Buzzi G, Ambrosetto P (2000) Wernicke-korsakoff encephalopathy and polyneuropathy after gastroplasty for morbid obesity: report of a case. Arch Neurol 57:1356–1359CrossRefPubMed

Cui HW, Zhang BA, Peng T, Liu Y, Liu YR (2012) Wernicke's encephalopathy in a patient with acute pancreatitis: unusual cortical involvement and marvelous prognosis. Neurol Sci 33:615–618. doi:10.1007/s10072-011-0771-5 CrossRefPubMed

D'Aprile P, Tarantino A, Santoro N, Carella A (2000) Wernicke's encephalopathy induced by total parenteral nutrition in patient with acute leukaemia: unusual involvement of caudate nuclei and cerebral cortex on MRI. Neuroradiology 42:781–783CrossRefPubMed

Donnino M (2004) Gastrointestinal beriberi: a previously unrecognized syndrome. Ann Intern Med 141:898–899CrossRefPubMed

Doss A, Mahad D, Romanowski CA (2003) Wernicke encephalopathy: unusual findings in nonalcoholic patients. J Comput Assist Tomogr 27:235–240CrossRefPubMed

Fei GQ et al (2008) Clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy. AJNR Am J Neuroradiol 29:164–169. doi:10.3174/ajnr.A0827 CrossRefPubMed

Foster D, Falah M, Kadom N, Mandler R (2005) Wernicke encephalopathy after bariatric surgery: losing more than just weight. Neurology 65:1987. doi:10.1212/01.wnl.0000188822.86529.f0 CrossRefPubMed

Galvin R, Brathen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 17:1408–1418. doi:10.1111/j.1468-1331.2010.03153.x CrossRefPubMed

Ghosh GC, Chatterjee K, Sharma B (2014) Non Alcoholic Wernicke’s Encephalopathy with Cortical Involvement in a Patient of Active Peptic Ulcer Disease. J Clin Case Rep 4:379. doi:10.4172/2165-7920.1000379

Haid RW, Gutmann L, Crosby TW (1982) Wernicke-Korsakoff encephalopathy after gastric plication. JAMA 247:2566–2567CrossRefPubMed

Harper CG, Giles M, Finlay-Jones R (1986) Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry 49:341–345CrossRefPubMedPubMedCentral

Iannelli A, Addeo P, Novellas S, Gugenheim J (2010) Wernicke's encephalopathy after laparoscopic Roux-en-Y gastric bypass: a misdiagnosed complication. Obes Surg 20:1594–1596. doi:10.1007/s11695-010-0116-0 CrossRefPubMed

Ishibashi S et al (2003) Reversible acute axonal polyneuropathy associated with Wernicke-Korsakoff syndrome: impaired physiological nerve conduction due to thiamine deficiency? J Neurol Neurosurg Psychiatry 74:674–676CrossRefPubMedPubMedCentral

Juhasz-Pocsine K, Rudnicki SA, Archer RL, Harik SI (2007) Neurologic complications of gastric bypass surgery for morbid obesity. Neurology 68:1843–1850. doi:10.1212/01.wnl.0000262768.40174.33 CrossRefPubMed

Koffman BM, Greenfield LJ, Ali II, Pirzada NA (2006) Neurologic complications after surgery for obesity. Muscle Nerve 33:166–176. doi:10.1002/mus.20394 CrossRefPubMed

Koike H, Iijima M, Mori K, Hattori N, Ito H, Hirayama M, Sobue G (2004) Postgastrectomy polyneuropathy with thiamine deficiency is identical to beriberi neuropathy. Nutrition 20:961–966. doi:10.1016/j.nut.2004.08.002 CrossRefPubMed

Koike H et al (2008) Rapidly developing weakness mimicking Guillain-Barre syndrome in beriberi neuropathy: two case reports. Nutrition 24:776–780. doi:10.1016/j.nut.2008.02.022 CrossRefPubMed

Koike H et al (2001) Postgastrectomy polyneuropathy with thiamine deficiency. J Neurol Neurosurg Psychiatry 71:357–362CrossRefPubMedPubMedCentral

Koike H, Watanabe H, Inukai A, Iijima M, Mori K, Hattori N, Sobue G (2006) Myopathy in thiamine deficiency: analysis of a case. J Neurol Sci 249:175–179. doi:10.1016/j.jns.2006.06.016 CrossRefPubMed

Kornreich L et al (2005) Thiamine deficiency in infants: MR findings in the brain. AJNR Am J Neuroradiol 26:1668–1674PubMed

Landais AF (2014) Rare neurologic complication of bariatric surgery: acute motor axonal neuropathy (AMAN), a severe motor axonal form of the Guillain Barre syndrome. Surg Obes Relat Dis. doi:10.1016/j.soard.2014.02.019

Lindboe CF, Loberg EM (1989) Wernicke's encephalopathy in non-alcoholics. An autopsy study J Neurol Sci 90:125–129CrossRefPubMed

Liu YT, Fuh JL, Lirng JF, Li AF, Ho DM, Wang SJ (2006) Correlation of magnetic resonance images with neuropathology in acute Wernicke's encephalopathy. Clin Neurol Neurosurg 108:682–687. doi:10.1016/j.clineuro.2005.05.010 CrossRefPubMed

Luigetti M, De Paulis S, Spinelli P, Sabatelli M, Tonali P, Colosimo C, Cianfoni A (2009) Teaching NeuroImages: the full-blown neuroimaging of Wernicke encephalopathy. Neurology 72:e115. doi:10.1212/WNL.0b013e3181a82647 CrossRefPubMed

Lyons DA, Linscott LL, Krueger DA (2016) Non-alcoholic Wernicke Encephalopathy. Pediatr Neurol 56:94–95. doi:10.1016/j.pediatrneurol.2015.12.007 CrossRefPubMed

Mascalchi M et al (1999) Do acute lesions of Wernicke's encephalopathy show contrast enhancement? Report of three cases and review of the literature. Neuroradiology 41:249–254CrossRefPubMed

Mechanick JI et al (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 21(Suppl 1):S1–27. doi:10.1002/oby.20461 CrossRef

Nolli M, Barbieri A, Pinna C, Pasetto A, Nicosia F (2005) Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging. Acta Anaesthesiol Scand 49:1566–1570. doi:10.1111/j.1399-6576.2005.00879.x CrossRefPubMed

Pereira DB, Pereira ML, Gasparetto EL (2011) Nonalcoholic Wernicke encephalopathy with extensive cortical involvement: cortical laminar necrosis and hemorrhage demonstrated with susceptibility-weighted MR phase images. AJNR Am J Neuroradiol 32:E37–E38. doi:10.3174/ajnr.A2359 CrossRefPubMed

Phua KH, Goh LG, Koh K, Ong CN, Tan TC, Wong ML, Lee HP (1990) Thiamine deficiency and sudden deaths: lessons from the past. Lancet 335:1471–1472CrossRefPubMed

Rufa A et al (2011) Wernicke encephalopathy after gastrointestinal surgery for cancer: causes of diagnostic failure or delay. Int J Neurosci 121:201–208. doi:10.3109/00207454.2010.544430 CrossRefPubMed

Sakurai K, Sasaki S, Hara M, Yamawaki T, Shibamoto Y (2009) Wernicke's encephalopathy with cortical abnormalities: clinicoradiological features: report of 3 new cases and review of the literature. Eur Neurol 62:274–280. doi:10.1159/000235596 CrossRefPubMed

Santos Andrade C, Tavares Lucato L, da Graca Morais Martin M, Joaquina Marques-Dias M, Antonio Pezzi Portela L, Scarabotolo Gattas G, da Costa LC (2010) Non-alcoholic Wernicke's encephalopathy: broadening the clinicoradiological spectrum. Br J Radiol 83:437–446. doi:10.1259/bjr/27226205 CrossRefPubMedPubMedCentral

Sauberlich HE, Herman YF, Stevens CO, Herman RH (1979) Thiamin requirement of the adult human. Am J Clin Nutr 32:2237–2248PubMed

Sechi G, Sechi E, Fois C, Kumar N (2016) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutr Rev 74:281–300. doi:10.1093/nutrit/nuv107 CrossRefPubMed

Sechi G, Serra A (2007) Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 6:442–455. doi:10.1016/s1474-4422(07)70104-7 CrossRefPubMed

Singh S, Kumar A (2007) Wernicke encephalopathy after obesity surgery: a systematic review. Neurology 68:807–811. doi:10.1212/01.wnl.0000256812.29648.86 CrossRefPubMed

Sohoni C (2014) Usefulness of Magnetic Resonance Imaging in the Diagnosis of Non-Alcoholic Wernicke's Encephalopathy. Ann Med Health Sci Res 4:S163–S164. doi:10.4103/2141-9248.138049 CrossRefPubMedPubMedCentral

Takahashi K, Nakamura H (1976) Axonal degeneration in beriberi neuropathy. Arch Neurol 33:836–841CrossRefPubMed

Thaisetthawatkul P, Collazo-Clavell ML, Sarr MG, Norell JE, Dyck PJ (2004) A controlled study of peripheral neuropathy after bariatric surgery. Neurology 63:1462–1470CrossRefPubMed

Watson JT et al (2011) Outbreak of beriberi among African Union troops in Mogadishu, Somalia. PLoS One 6:e28345. doi:10.1371/journal.pone.0028345 CrossRefPubMedPubMedCentral

Wicklund MR, Knopman DS (2013) Brain MRI findings in Wernicke encephalopathy. Neurol Clin Pract 3:363–364. doi:10.1212/CPJ.0b013e3182a1ba00 CrossRefPubMedPubMedCentral

Wilkinson TJ, Hanger HC, George PM, Sainsbury R (2000) Is thiamine deficiency in elderly people related to age or co-morbidity? Age Ageing 29:111–116CrossRefPubMed

Wu L, Jin D, Sun X, Liang L, Huang D, Dong Z, Yu S (2016) Cortical damage in Wernicke's encephalopathy with good prognosis: a report of two cases and literature review. Metab Brain Dis. doi:10.1007/s11011-016-9920-0

Yamashita M, Yamamoto T (1995) Wernicke encephalopathy with symmetric pericentral involvement: MR findings. J Comput Assist Tomogr 19:306–308CrossRefPubMed

Yoon JH, Yong SW, Yong SW, Lee PH (2009) Dystonic hand tremor in a patient with Wernicke encephalopathy. Parkinsonism Relat Disord 15:479–481. doi:10.1016/j.parkreldis.2008.10.007 CrossRefPubMed

Zhong C, Jin L, Fei G (2005) MR Imaging of nonalcoholic Wernicke encephalopathy: a follow-up study. AJNR Am J Neuroradiol 26:2301–2305PubMed

Zuccoli G, Cravo I, Bailey A, Venturi A, Nardone R (2011) Basal Ganglia involvement in Wernicke encephalopathy: report of 2 cases. AJNR Am J Neuroradiol 32:E129–E131. doi:10.3174/ajnr.A2185 CrossRefPubMed

Zuccoli G, Pipitone N (2009) Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol 192:501–508. doi:10.2214/ajr.07.3959 CrossRefPubMed

Zuccoli G, Santa Cruz D, Bertolini M, Rovira A, Gallucci M, Carollo C, Pipitone N (2009) MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 30:171–176. doi:10.3174/ajnr.A1280 CrossRefPubMed

Title: Non-alcoholic Wernicke’s encephalopathy with cortical involvement and polyneuropathy following gastrectomy
Authors: Wei-Chia Tsao
Long-Sun Ro
Chiung-Mei Chen
Hong-Chiu Chang
Hung-Chou Kuo
Publication date: 01-10-2017
Publisher: Springer US
Published in: Metabolic Brain Disease / Issue 5/2017
Print ISSN: 0885-7490
Electronic ISSN: 1573-7365
DOI: https://doi.org/10.1007/s11011-017-0055-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-alcoholic Wernicke’s encephalopathy with cortical involvement and polyneuropathy following gastrectomy

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2017

The treatment of juvenile/adult GM1-gangliosidosis with Miglustat may reverse disease progression

Estrogen protects both sexes against EAE by promoting common regulatory cell subtypes independent of endogenous estrogen

Increased autophagic degradation contributes to the neuroprotection of hydrogen sulfide against cerebral ischemia/reperfusion injury

Dynamic complexity measures and entropy paths for modelling and comparison of evolution of patients with drug resistant epileptic encephalopathy syndromes (DREES)

Inhibition of NF-κB activity by aminoguanidine alleviates neuroinflammation induced by hyperglycemia

Tryptophan status in autism spectrum disorder and the influence of supplementation on its level