Department of Psycho-Oncology,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Department of Palliative Medicine,Saitama Medical University,Saitama International Medical Center,Saitama,Japan.
Palliat Support Care. 2018 Feb;16(1):118-121. doi: 10.1017/S1478951517000360. Epub 2017 May 3.
Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. Several reports of WE in cancer patients are known. WE is sometimes overlooked because most patients do not exhibit its typical symptoms (e.g., delirium, ataxia, ocular palsy). If delirium is not present, a diagnosis of WE is difficult because delirium is the hallmark symptom of WE.
Taken from a series on WE in cancer, we report two patients who developed WE without delirium during periodic psycho-oncology outpatient visits.
Case 1. A 61-year-old woman with non-Hodgkin lymphoma who was periodically attending a psycho-oncology outpatient clinic developed an unsteady gait. WE was suspected because she also developed appetite loss for two weeks, and we could find no other laboratory findings to explain her unsteady gait. Our diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after intravenous thiamine administration. Case 2. A 50-year-old woman with breast carcinoma with bone metastasis developed an unsteady gait. WE was suspected because she also developed loss of appetite for two weeks, and no other laboratory findings could explain her unsteady gait. The diagnosis was supported by abnormal serum thiamine and disappearance of the gait disturbance after administration of intravenous thiamine.
Our report emphasizes the importance of being aware of WE, even when patients do not present with delirium. The presence of loss of appetite for more than two weeks may be the key to a diagnosis of WE.
Wernicke 脑病（WE）是由硫胺素缺乏引起的一种神经精神障碍。已知有几例癌症患者发生 WE 的报告。WE 有时会被忽视，因为大多数患者没有表现出其典型症状（例如，意识混乱、共济失调、眼肌瘫痪）。如果没有出现意识混乱，WE 的诊断就很困难，因为意识混乱是 WE 的标志性症状。
从癌症 WE 系列中，我们报告了两名在定期进行心理肿瘤学门诊就诊时没有出现意识混乱的 WE 患者。
病例 1. 一名 61 岁的非霍奇金淋巴瘤女性患者定期参加心理肿瘤学门诊就诊时出现步态不稳。由于她还出现了两周的食欲不振，我们找不到其他实验室发现可以解释她的步态不稳，因此怀疑她患有 WE。我们的诊断得到了异常血清硫胺素和静脉注射硫胺素后步态紊乱消失的支持。病例 2. 一名 50 岁的乳腺癌伴骨转移女性患者出现步态不稳。由于她还出现了两周的食欲不振，我们找不到其他实验室发现可以解释她的步态不稳，因此怀疑她患有 WE。诊断得到了异常血清硫胺素和静脉注射硫胺素后步态紊乱消失的支持。
我们的报告强调了即使患者没有出现意识混乱，也要意识到 WE 的重要性。食欲不振持续两周以上可能是 WE 诊断的关键。
