Choi Evan Y, Gomes William A, Haigentz Missak, Graber Jerome J
Department of Neurology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (E.Y.C, J.J.G.); Assistant Professor, Department of Radiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (W.A.G.); Associate Professor of Clinical Medicine, Department of Medicine (Oncology), Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (M.H.).
Neurooncol Pract. 2016 Sep;3(3):196-207. doi: 10.1093/nop/npv036. Epub 2015 Sep 22.
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.
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.
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.
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.
韦尼克脑病是一种严重的医学病症，与硫胺素缺乏导致的高发病率和死亡率相关。这种疾病传统上与酒精中毒有关，但在非酒精人群中未得到充分认识。恶性肿瘤患者中韦尼克脑病的发生越来越受到关注。
我们在PubMed上对恶性肿瘤患者中发生的韦尼克脑病病例进行了文献综述。我们还介绍了一名47岁复发性喉癌女性的病例，该患者因营养不良多次住院。神经系统检查发现有摆动性眼球震颤、严重步态共济失调、意识模糊和记忆巩固障碍。脑部MRI显示中脑导水管周围区域、内侧丘脑和顶盖在T2加权液体衰减反转恢复序列上呈高信号，这是韦尼克脑病的典型表现。她接受了硫胺素补充治疗，精神状态有明显改善，视力问题和共济失调也有一定改善，尽管仍有一些眼球震颤和明显的短期记忆障碍。
文献综述得出了几十例恶性肿瘤患者韦尼克脑病的病例报告，以胃肠道系统恶性肿瘤患者病例为主，其次是血液系统恶性肿瘤患者。
恶性肿瘤是韦尼克脑病发生的重要危险因素。这种诊断未得到充分认识，临床医生难以从多因素谵妄中辨别出来。临床医生应意识到立即对高危患者进行硫胺素治疗，特别是在存在多种危险因素的情况下。
