Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Acute cerebellar ataxia in a young woman: Wernicke’s encephalopathy?

https://doi.org/10.14412/2074-2711-2015-4-27-32

Full Text:

Abstract

Wernicke’s encephalopathy (WE) is a rare but severe neurological syndrome caused by thiamine deficiency. According to the data of autopsy studies, the prevalence of WE in the general population varies from 0.4 to 2.8 per 100,000 population; the disease occurs many times more frequently in alcohol abusers than in people who lead a healthy lifestyle. These studies also showed that most cases of WE were diagnosed postmortem; less than 20% of patients with the disease were diagnosed in life. A healthy adult requires 1–2 mg of thiamine daily, depending on the carbohydrate intake. Body’s reserves of thiamine are only 30–50 mg so any malnutrition condition lasting more than 3–4 weeks can cause complete depletion of the vitamin’s stores. Classically, WE is characterized by the sudden onset of a typical triad of symptoms: an altered mental state, ophthalmoplegia, and ataxia. However, this clinical picture can be seen in only one-third of patients. The onset of the disease may sometimes look completely different: heart failure with hypotension and tachycardia; gastrointestinal symptoms (abdominal pain and nausea); hypothermia due to the involvement of the posterior hypothalamus; deafness affecting the thalamus; epileptic seizures in case of enhanced activity of the glutamatergic system.

The paper describes a clinical case of acute cerebellar ataxia that is apparently caused by Wernicke’s encephalopathy in a young woman.

About the Authors

S. G. Dolgova
M.F. Vladimirskiy Moscow Regional Clinical Research Institute
Russian Federation
61/2 Shchepkin St., Moscow 129110


A. S. Kotov
M.F. Vladimirskiy Moscow Regional Clinical Research Institute
Russian Federation
61/2 Shchepkin St., Moscow 129110


Yu. V. Matyuk
M.F. Vladimirskiy Moscow Regional Clinical Research Institute
Russian Federation
61/2 Shchepkin St., Moscow 129110


M. N. Borisova
M.F. Vladimirskiy Moscow Regional Clinical Research Institute
Russian Federation
61/2 Shchepkin St., Moscow 129110


M. V. Panteleeva
M.F. Vladimirskiy Moscow Regional Clinical Research Institute
Russian Federation
61/2 Shchepkin St., Moscow 129110


A. V. Shatalin
M.F. Vladimirskiy Moscow Regional Clinical Research Institute
Russian Federation
61/2 Shchepkin St., Moscow 129110


References

1. Wernicke C. Die akute haemorrhagische polioencephalitis superior. Lehrbuch der Gehirnkrankheiten fur Aerzte und Studirende. Vol. 2. P. 229–42. Fisher: Kassel, Germany; 1881.

2. Ueda K, Takada D, Mii A, et al. Severe thiamine deficiency resulted in Wernicke's encephalopathy in a chronic dialysis patient. Clin Exp Nephrol. 2006 Dec;10(4):290-3. doi: 10.1007/s10157-006-0440-9

3. Nolli M, Barbieri A, Pinna C, et al. Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging. Acta Anaesthesiol Scand. 2005 Nov;49(10):1566-70. doi: 10.1111/j.1399-6576.2005.00879.x

4. Yae S, Okuno S, Onishi H, Kawanishi C. Development of Wernicke encephalopathy in a terminally ill cancer patient consuming an adequate diet: a case report and review of the literature. Palliat Support Care. 2005 Dec;3(4): 333-5. doi: 10.1017/S1478951505050509.

5. Cho IJ, Chang HJ, Lee KE, et al. A case of Wernicke's encephalopathy following fluorouracil-based chemotherapy. J Korean Med Sci. 2009 Aug;24(4):747-50. doi: 10.3346/jkms.2009.24.4.747.

6. Baek JH, Sohn SK, Kim DH, et al. Wernicke's encephalopathy after allogeneic stem cell transplantation. Bone Marrow Transplant. 2005 Apr;35(8):829-30. doi: 10.1038/sj.bmt.1704893.

7. Saad L, Silva LF, Banzato CE, et al. Anorexia nervosa and Wernicke-Korsakoff syndrome: a case report J Med Case Rep. 2010 Jul 20;4:217. doi: 10.1186/1752-1947-4-217.

8. Unlu E, Cakir B, Asil T. MRI findings of Wernicke encephalopathy revisited due to hunger strike. Eur J Radiol. 2006 Jan;57(1): 43-53. doi: 10.1016/j.ejrad.2005.07.002.

9. Francini-Pesenti F, Brocadello F, Manara R, et al. Wernicke's syndrome during parenteral feeding: not an unusual complication. Nutrition. 2009 Feb;25(2):142-6. doi: 10.1016/j.nut.2008.08.003.

10. Gui QP, Zhao WQ, Wang LN. Wernicke's encephalopathy in nonalcoholic patients: clinical and pathologic features of three cases and literature reviewed. Neuropathology. 2006 Jun;26(3):231-5. doi: 10.1111/j.1440-1789.2006.00665.x.

11. Doss A, Mahad D, Romanowski CA. Wernicke encephalopathy: unusual findings in nonalcoholic patients. J Comput Assist Tomogr. 2003 Mar-Apr;27(2):235-40.

12. Zhang SQ, Guan YT. Acute bilateral deafness as the first symptom of Wernicke encephalopathy. AJNR Am J Neuroradiol. 2012 Mar;33(3):E44-5. doi: 10.3174/ajnr.A3040.

13. Caine D, Halliday GM, Kril JJ, Harper CG. Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy. J Neurol Neurosurg Psychiatry. 1997 Jan;62(1):51-60.

14. Fei GQ, Zhong C, Jin L, et al. Clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy. AJNR Am J Neuroradiol. 2008 Jan;29(1):164-9.

15. Chung SP, Kim SW, Yoo IS, et al. Magnetic resonance imaging as a diagnostic adjunct to Wernicke encephalopathy in the ED. Am J Emerg Med. 2003 Oct;21(6):497-502.

16. Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol. 2009 Feb;192(2):501-8.

17. Gangolf M, Czerniecki J, Radermecker M, et al. Thiamine status in humans and content of phosphorylated thiamine derivatives in biopsies and cultured cells. PLoS One. 2010 Oct 25;5(10):e13616.

18. Sullivan EV, Pfefferbaum A. Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol. 2009 Mar-Apr;44(2):155-65.

19. Nardone R, Venturi A, Golaszewski S, et al. MR atypical Wernicke encephalopathy showing extensive brain stem and diencephalic involvement. J Neuroimaging. 2010 Apr;20(2):204-7.

20. Kang SY, Kang JH, Choi JC, Choi G. Wernicke's encephalopathy: unusual manifestation on MRI. J Neurol. 2005 Dec;252(12):1550-2.

21. Kalidass B, Sunnathkal R, Rangashamanna DV, Paraswani R. Atypical Wernicke's encephalopathy showing involvement of substantia nigra. J Neuroimaging. 2012 Apr;22(2):204-7.

22. Lapergue B, Klein I, Olivot JM, Amarenco P. Diffusion weighted imaging of cerebellar lesions in Wernicke's encephalopathy. J Neuroradiol. 2006 Apr;33(2):126-8.

23. Cui HW, Zhang BA, Peng T, et al. Wernicke's encephalopathy in a patient with acute pancreatitis: unusual cortical involvement and marvelous prognosis. Neurol Sci. 2012 Jun;33(3):615-8.

24. Zhong C, Jin L, Fei G. MR Imaging of nonalcoholic Wernicke encephalopathy: a follow-up study. AJNR Am J Neuroradiol. 2005 Oct;26(9):2301-5.

25. Liou KC, Kuo SF, Chen LA. Wernicke encephalopathy with atypical magnetic resonance imaging. Am J Emerg Med. 2012 Nov;30(9):2086.e1-3. doi: 10.1016/j.ajem.2011.12.013. Epub 2012 Feb 4.

26. Donnino MW, Vega J, Miller J, Walsh M. Myths and misconceptions of Wernicke's encephalopathy: what every emergency physician should know. Ann Emerg Med. 2007 Dec;50(6):715-21.

27. Galvin R, Brаthen G, Ivashynka A, et al; EFNS. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010 Dec;17(12):1408-18.

28. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007 May;6(5):442-55.


For citation:


Dolgova S.G., Kotov A.S., Matyuk Y.V., Borisova M.N., Panteleeva M.V., Shatalin A.V. Acute cerebellar ataxia in a young woman: Wernicke’s encephalopathy? Neurology, Neuropsychiatry, Psychosomatics. 2015;7(4):27-32. (In Russ.) https://doi.org/10.14412/2074-2711-2015-4-27-32

Views: 345


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)