Isenberg-Grzeda Elie, Hsu Alan John, Hatzoglou Vaios, Nelso Christian, Breitbart William
Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York.
VA San Diego Healthcare System,San Diego,California.
Palliat Support Care. 2015 Oct;13(5):1241-9. doi: 10.1017/S1478951514001163. Epub 2014 Oct 23.
Thiamine-related encephalopathy (Wernicke's encephalopathy) is a neuropsychiatric syndrome caused by a vitamin B1 (thiamine) deficiency often associated with alcoholism. Cancer predisposes patients to thiamine deficiency unrelated to alcoholism, though many cases are missed clinically. The present report adds to the literature on thiamine as a palliative tool for thiamine-related encephalopathy (TRE) in cancer.
From a larger series of TRE in cancer, we report on three cases with terminal illness.
Case 1. A 61-year old woman with Hodgkin's lymphoma developed TRE over 13 days. Precipitants included a hypermetabolic state in the background of subacute thiamine deficiency. Diagnosis was supported by abnormal serum thiamine and positive MRI findings. Mental status improved within 36 hours of initiating thiamine 500 mg IV t.i.d. Case 2. A 68-year-old man with colon cancer metastatic to liver and bone developed TRE precipitated by C. difficile-related diarrhea superimposed on 3 months of low appetite and weight loss. Diagnosis was supported by abnormal serum thiamine, and thiamine 500 mg IV t.i.d. was initiated. Improvements in mental status began within 36 hours. Case 3. An 80-year-old man with squamous cell carcinoma developed TRE precipitated by systemic infection in the context of three weeks of dysphagia. Antibiotic treatment did not reverse his cognitive symptoms, and a diagnosis of TRE was made based on operationalized criteria. Thiamine 100 mg IV daily did not reverse his symptoms. On his 30th day of admission, thiamine was increased to 500 mg IV t.i.d., resulting in a rapid reversal of altered mental status.
This report adds to the list of cancer types in which TRE/Wernicke's encephalopathy has been reported. It supports the use of higher doses of thiamine than are typically recommended in North America. Improvement following treatment allowed patients to engage with family and treatment teams prior to death.
硫胺素相关脑病（韦尼克脑病）是一种神经精神综合征，由维生素B1（硫胺素）缺乏引起，常与酒精中毒相关。癌症使患者易患与酒精中毒无关的硫胺素缺乏症，尽管许多病例在临床上被漏诊。本报告补充了关于硫胺素作为癌症中硫胺素相关脑病（TRE）姑息治疗工具的文献。
从一系列癌症患者的TRE病例中，我们报告了3例晚期疾病患者。
病例1。一名61岁的霍奇金淋巴瘤女性在13天内发展为TRE。诱发因素包括亚急性硫胺素缺乏背景下的高代谢状态。血清硫胺素异常和MRI阳性结果支持诊断。开始静脉注射硫胺素500毫克，每日3次后36小时内精神状态改善。病例2。一名68岁的结肠癌肝转移和骨转移男性，在3个月食欲减退和体重减轻的基础上，因艰难梭菌相关性腹泻诱发TRE。血清硫胺素异常支持诊断，开始静脉注射硫胺素500毫克，每日3次。36小时内精神状态开始改善。病例3。一名80岁的鳞状细胞癌男性，在吞咽困难3周的情况下，因全身感染诱发TRE。抗生素治疗未能逆转其认知症状，根据操作性标准诊断为TRE。每日静脉注射硫胺素100毫克未能逆转其症状。入院第30天，硫胺素增加至静脉注射500毫克，每日3次，导致精神状态改变迅速逆转。
本报告增加了已报告TRE/韦尼克脑病的癌症类型清单。它支持使用比北美通常推荐剂量更高的硫胺素。治疗后的改善使患者在死亡前能够与家人和治疗团队互动。
