Top

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Published in:

Open Access 01-12-2023 | Schizophrenia | Case Report

Gayet–Wernicke encephalopathy: a complication not to be overlooked in patients with catatonic schizophrenia

Authors: Neila Messedi, Mariem Turki, Rihab Charfi, Sahar Ellouze, Imen Chaari, Lobna Aribi, Najla Halouani, Jihen Aloulou

Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Issue 1/2023

Abstract

Background

Gayet–Wernicke's encephalopathy (GWE) is a life-threatening neurological emergency caused by vitamin B1 deficiency. This is a rare complication, which may be reversible if managed promptly. However, any diagnostic or therapeutic delay exposes to the risk of serious sequelae. Although this pathology frequently occurs in chronic alcohol users, it can also occur in any situation of severe undernutrition. In this context, we report a case of GWE occurring after severe undernutrition complicating prolonged catatonia in a patient suffering from schizophrenia.

Case presentation

He was a 47-year-old patient, suffering from esophageal stenosis, and followed in psychiatry for schizophrenia, who was hospitalized for a catatonic relapse. He was put on benzodiazepine with parenteral rehydration. Faced with the persistence of food refusal, and the appearance of signs of undernutrition, a parenteral diet was introduced. The evolution was marked by the deterioration of his general and neurological condition, with the appearance of mental confusion. The examination showed a central vestibular syndrome, and brain magnetic resonance imaging showed a hyperintense signaling in the periaqueductal area, in mammillary bodies, and in medial thalamic nuclei on T2-FLAIR sequences. GWE was suspected and parental vitamin B1 therapy was initiated. Laboratory testing confirmed the diagnosis, showing a low thiamine blood level of 32 nmol/l [normal range: 78 to 185 nmol/l]. Regression of neurological symptoms was observed within 2 weeks of treatment.

Conclusion

Through this illustration, we draw the attention of the psychiatrist, who must think about preventing this complication, by supplementing any patient at risk of developing GWE with vitamin B1.

Adioui T, Nejjari F, Tamzaourte M, Basr H, Rouibaa F, Aourarh A. Gayet-Wernicke encephalopathy: a rare complication of prolonged parenteral nutrition. Presse Med. 2015;44(5):561–4. https://doi.org/10.1016/j.lpm.2014.11.012.CrossRefPubMed

Boulanger AS, Paquette I, Létourneau G, Richard-Devantoy S. Wernicke encephalopathy: guiding thiamine prescription. Encephale. 2017;43(3):259–67. https://doi.org/10.1016/j.encep.2016.04.011.CrossRefPubMed

Zhao L, Hou B, Ji L, Ren D, Yuan F, Liu L, Bi Y, et al. NGFR gene and single nucleotide polymorphisms, rs2072446 and rs11466162, playing roles in psychiatric disorders. Brain Sci. 2022;12(10):1372. https://doi.org/10.3390/brainsci12101372.CrossRefPubMedPubMedCentral

Tanaka M, Tóth F, Polyák H, Szabó Á, Mándi Y, Vécsei L. Immune influencers in action: metabolites and enzymes of the tryptophan-kynurenine metabolic pathway. Biomedicines. 2021;9(7):734. https://doi.org/10.3390/biomedicines9070734.CrossRefPubMedPubMedCentral

Tanaka M, Spekker E, Szabó Á, Polyák H, Vécsei L. Modelling the neurodevelopmental pathogenesis in neuropsychiatric disorders. Bioactive kynurenines and their analogues as neuroprotective agents-in celebration of 80th birthday of Professor Peter Riederer. J Neural Transm. 2022;129(5–6):627–42. https://doi.org/10.1007/s00702-022-02513-5.CrossRefPubMed

Nyatega CO, Qiang L, Adamu MJ, Younis A, Kawuwa HB. Altered dynamic functional connectivity of cuneus in schizophrenia patients: a resting-state fMRI study. Appl Sci. 2021;11:11392. https://doi.org/10.3390/app112311392.CrossRef

Gaebler AJ, Finner-Prével M, Sudar FP, et al. The interplay between Vitamin D, exposure of anticholinergic antipsychotics and cognition in schizophrenia. Biomedicines. 2022;10(5):1096. https://doi.org/10.3390/biomedicines10051096.CrossRefPubMedPubMedCentral

Panov GP. Early markers in resistant schizophrenia: effect of the first antipsychotic drug. Diagnostics. 2022;12(4):803. https://doi.org/10.3390/diagnostics12040803.CrossRefPubMedPubMedCentral

Du XD, Li Z, Yuan N, Yin M, Zhao XL, Lv XL, et al. Delayed improvements in visual memory task performance among chronic schizophrenia patients after high-frequency repetitive transcranial magnetic stimulation. World J Psychiatry. 2022;12(9):1169–82. https://doi.org/10.5498/wjp.v12.i9.1169.CrossRefPubMedPubMedCentral

10.

Tanaka M, Szabó Á, Spekker E, Polyák H, Tóth F, Vécsei L. Mitochondrial impairment: a common motif in neuropsychiatric presentation? The link to the tryptophan-kynurenine metabolic system. Cells. 2022;11(16):2607. https://doi.org/10.3390/cells11162607.CrossRefPubMedPubMedCentral

11.

Burke T, Gleeson C, Holleran L, Mothersill D, Holland J, Costello L, et al. Corpus callosum microstructural tract integrity relates to longer emotion recognition reaction time in people with schizophrenia. Brain Sci. 2022;12(9):1208. https://doi.org/10.3390/brainsci12091208.CrossRefPubMedPubMedCentral

12.

Onu JU, Osuji PN. Double burden of malnutrition amongst patients with first-episode schizophrenia in a psychiatric hospital: a 1-year follow-up study. S Afr J Psychiatr. 2020;26:1564. https://doi.org/10.4102/sajpsychiatry.v26i0.1564.CrossRefPubMedPubMedCentral

13.

Harrison RA, Vu T, Hunter AJ. Wernicke’s encephalopathy in a patient with schizophrenia. J Gen Intern Med. 2006;21(12):C8–11. https://doi.org/10.1111/j.1525-1497.2006.00600.x.CrossRefPubMedPubMedCentral

14.

He J, Li J, Li Z, Ren H, Chen X, Tang J. A case report of Wernicke’s encephalopathy associated with schizophrenia. Front Psychiatry. 2021;12:657649. https://doi.org/10.3389/fpsyt.2021.657649.CrossRefPubMedPubMedCentral

15.

Oudman E, Wijnia JW, Oey MJ, van Dam M, Postma A. Wernicke-Korsakoff syndrome despite no alcohol abuse: a summary of systematic reports. J Neurol Sci. 2021;426:117482. https://doi.org/10.1016/j.jns.2021.117482.CrossRefPubMed

16.

Seo Y, Reed M, Chang JS, Lui F. Wernicke’s encephalopathy presenting with confusion in a patient with schizophrenia. Cureus. 2022;14(12):e32320. https://doi.org/10.7759/cureus.32320.CrossRefPubMedPubMedCentral

17.

Oudman E. Wernicke encephalopathy in patients with depression: a systematic review. Psychiatry Clin Neurosci. 2020;74(10):569–72. https://doi.org/10.1111/pcn.13113.CrossRefPubMedPubMedCentral

18.

Oudman E, Wijnia JW, Oey MJ, van Dam MJ, Postma A. Wernicke Encephalopathy in schizophrenia: a systematic review. Int J Psychiatry Clin Pract. 2021;25(3):233–7. https://doi.org/10.1080/13651501.2020.1819333.CrossRefPubMed

19.

Henneman DH, Altschule MD, Goncz RM. Carbohydrate metabolism in brain disease. II. Glucose metabolism in Schizophrenic, manic-depressive, and involutional psychoses. AMA Arch Intern Med. 1954;94(3):402–16. https://doi.org/10.1001/archinte.1954.00250030072008.CrossRefPubMed

20.

Sacks W. Cerebral metabolism of glucose-3-C14, pyruvate-1-C14 and lactate-1-C14 in mental disease. J Appl Physiol. 1961;16:175–80. https://doi.org/10.1152/jappl.1961.16.1.175.CrossRefPubMed

21.

Tsai HY, Lieh Yeh T, Sheei-Meei W, Chen PS, Yang YK. Starvation-induced Wernicke’s encephalopathy in schizophrenia. Psychiatry Clin Neurosci. 2004;58(3):338–9. https://doi.org/10.1111/j.1440-1819.2004.01242.x.CrossRefPubMed

22.

Tsai AC, Chou YT, Chang TL. Usefulness of the Mini Nutritional Assessment (MNA) in predicting the nutritional status of people with mental disorders in Taiwan. J Clin Nurs. 2011;20(3–4):341–50. https://doi.org/10.1111/j.1365-2702.2010.03467.x.CrossRefPubMed

23.

Kim SR, Kim JY, Kim HY, Nho JH, Kim YH, Min SY. Factors related to malnutrition in community-dwelling patients with schizophrenia. Perspect Psychiatr Care. 2019;55(3):415–23. https://doi.org/10.1111/ppc.12327.CrossRefPubMed

24.

Langlois M, Doré MC, Laforce R Jr. Thirty days without a bite: Wernicke’s encephalopathy in a patient with paranoid schizophrenia. J Neurol Disord. 2014;2:182. https://doi.org/10.4172/2329-6895.1000182.CrossRefPubMedPubMedCentral

25.

Durmaz O, Aktaş S, Akkişi KN. From psychosis to Wernicke encephalopathy: a case of hunger strike in prison. Neurocase. 2020;26(4):248–51. https://doi.org/10.1080/13554794.2020.1786587.CrossRefPubMed

26.

MacDonell JE, Wrenn K. Hypothermia in the summer. South Med J. 1991;84(6):804–5. https://doi.org/10.1097/00007611-199106000-00038.CrossRefPubMed

27.

Spittle B, Parker J. Wernicke’s encephalopathy complicating schizophrenia. Aust N Z J Psychiatry. 1993;27(4):638–52. https://doi.org/10.3109/00048679309075827.CrossRefPubMed

28.

Doraiswamy PM, Massey EW, Enright K, Palese VJ, Lamonica D, Boyko O. Wernicke-Korsakoff syndrome caused by psychogenic food refusal: MR findings. AJNR Am J Neuroradiol. 1994;15(3):594–6.PubMedPubMedCentral

29.

Casanova MF. Wernicke’s disease and schizophrenia: a case report and review of the literature. Int J Psychiatry Med. 1996;26(3):319–28. https://doi.org/10.2190/GD76-1UP3-TR18-YPYH.CrossRefPubMed

30.

Newman ME, Adityanjee, Sobolewski E, Jampala VC. Wernicke-Korsakoff amnestic syndrome secondary to malnutrition in a patient with schizoaffective disorder. Neuropsychiatry Neuropsychol Behav Neurol. 1998;11(4):241–4.PubMed

31.

Kaineg B, Hudgins PA. Images in clinical medicine. Wernicke’s encephalopathy. N Engl J Med. 2005;352(19):e18. https://doi.org/10.1056/NEJMicm040862.CrossRefPubMed

32.

Salawu F, Kwajaffa S. Wernicke’s encephalopathy in a Nigerian with schizophrenia. Ann Afr Med. 2007;6(4):200–2. https://doi.org/10.4103/1596-3519.55695.CrossRefPubMed

33.

Harrington C, Froehlich W. Peculiar behavior and cognitive dysfunction in a patient with schizophrenia: Wernicke-Korsakoff syndrome in disguise. J Neuropsychiatry Clin Neurosci. 2007;19:219–20.

34.

Park JC, Park SY, Kim DW, Kim SH, Kim EH, Lee SJ, et al. Wernicke-Korsakoff encephalopathy following cancer treatment in a patient with schizophrenia [in Korean]. Korean J Med. 2009;77:S1289–92.

35.

McCormick LM, Buchanan JR, Onwuameze OE, Pierson RK, Paradiso S. Beyond alcoholism: Wernicke-Korsakoff syndrome in patients with psychiatric disorders. Cogn Behav Neurol. 2011;24(4):209–16. https://doi.org/10.1097/WNN.0b013e31823f90c4.CrossRefPubMedPubMedCentral

36.

Felix O, Felleiter P, Sturzenegger M. Life-threatening complication of schizophrenia. Praxis. 2012;101(2):127–31. https://doi.org/10.1024/1661-8157/a000820.CrossRefPubMed

37.

Hargrave DD, Schroeder RW, Heinrichs RJ, Baade LE. Wernicke-Korsakoff syndrome as a consequence of delusional food refusal: a case study. Cogn Behav Neurol. 2015;28(4):215–9. https://doi.org/10.1097/WNN.0000000000000079.CrossRefPubMed

38.

Cardinale M, Faivre A, La Folie T, Romand F, Alla P. Wernicke’s encephalopathy following prolonged parenteral nutrition. Presse Med. 2010;39(9):1001–2. https://doi.org/10.1016/j.lpm.2009.11.018.CrossRefPubMed

39.

Jung YC, Chanraud S, Sullivan EV. Neuroimaging of Wernicke’s encephalopathy and Korsakoff’s syndrome. Neuropsychol Rev. 2012;22(2):170–80. https://doi.org/10.1007/s11065-012-9203-4.CrossRefPubMedPubMedCentral

40.

National Institute of Health and Clinical Excellence (NICE). Alcohol-use disorders diagnosis and clinical management of alcohol-related physical complications. London: Nice; 2010. p. 4–30.

41.

Chandrakumar A, Bhardwaj A, ’t Jong GW. Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis. J Basic Clin Physiol Pharmacol. 2018;30(2):153–62. https://doi.org/10.1515/jbcpp-2018-0075.CrossRefPubMed

Title: Gayet–Wernicke encephalopathy: a complication not to be overlooked in patients with catatonic schizophrenia
Authors: Neila Messedi
Mariem Turki
Rihab Charfi
Sahar Ellouze
Imen Chaari
Lobna Aribi
Najla Halouani
Jihen Aloulou
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Schizophrenia
Encephalopathy
Neurological Emergencies
Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery / Issue 1/2023
Electronic ISSN: 1687-8329
DOI: https://doi.org/10.1186/s41983-023-00651-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gayet–Wernicke encephalopathy: a complication not to be overlooked in patients with catatonic schizophrenia

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Assessment of endovascular embolization of cerebral arterio-venous malformations in vertebrobasilar domain

Pattern and frequency of involuntary movements: hospital-based study

Gender disparity versus equality in acute stroke: a Middle Eastern country hospital-based study

The day after intracerebral hemorrhage: platelet mass index as predictor of survival—a retrospective cohort study

Low vitamin D serum levels as risk factor of Alzheimer’s disease: a systematic review and meta-analysis

Validation of brain parenchyma sonography as a marker of neurodegeneration in multiple sclerosis