Journal Article

Association between malignancy and non-alcoholic Wernicke's encephalopathy: a case report and literature review

Evan Y. Choi, William A. Gomes, Missak Haigentz and Jerome J. Graber

in Neuro-Oncology Practice

Published on behalf of The Society for Neuro-Oncology

Volume 3, issue 3, pages 196-207
Published in print September 2016 | ISSN: 2054-2577
Published online September 2015 | e-ISSN: 2054-2585 | DOI: https://dx.doi.org/10.1093/nop/npv036
Association between malignancy and non-alcoholic Wernicke's encephalopathy: a case report and literature review

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  • Medical Oncology
  • Palliative Medicine
  • Radiation Oncology
  • Clinical Radiology
  • Neurosurgery

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Background

Wernicke's encephalopathy is a serious medical condition associated with high morbidity and mortality caused by deficiency of thiamine. This disease is classically associated with alcoholism, but is underappreciated in the nonalcoholic population. There is growing acknowledgement of the development of Wernicke's encephalopathy in patients with malignancies.

Methods

We conducted a literature review in PubMed for cases of Wernicke's encephalopathy occurring in patients with malignancy. We also present the case of a 47-year-old woman with recurrent laryngeal cancer and multiple hospital admissions for malnutrition. Neurological examination was notable for pendular nystagmus, severe gait ataxia, confusion, and poor memory consolidation. MRI of the brain was significant for T2-weighted fluid-attenuated inversion recovery hyperintensities in periaqueductal regions, medial thalami, and the tectal plate, typical for Wernicke's encephalopathy. She was treated with thiamine repletion, and had marked improvement in her mental status and some improvement in her vision problems and ataxia, although some nystagmus and significant short-term memory impairment persisted.

Results

The literature review yielded dozens of case reports of Wernicke's encephalopathy in patients with malignancy, dominated by cases of patients with malignancies of the gastrointestinal system, followed by those with hematologic malignancies.

Conclusions

Malignancy is an important risk factor for the development of Wernicke's encephalopathy. This diagnosis is underappreciated and difficult for the clinician to discern from multifactorial delirium. Clinicians should be aware to treat at-risk patients with thiamine immediately, especially if multiple risk factors are present.

Keywords: cancer; encephalopathy; malignancy; non-alcoholic; Wernicke's

Journal Article.  5059 words.  Illustrated.

Subjects: Medical Oncology ; Palliative Medicine ; Radiation Oncology ; Clinical Radiology ; Neurosurgery

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