A - 102 Neuropsychological Findings in a Patient Diagnosed with Wernicke's Encephalopathy Due to Chemoradiation and Malnutrition: a Case Presentation.

Abstract

Wernicke's Encephalopathy (WE) is a rare neuropsychiatric syndrome caused by thiamine deficiency. WE is characterized by inattention, incoherence, confusion, eye-movement disorders, and ataxia. However, scarce information exists on neurocognitive outcomes, particularly stemming from oncology-related etiologies, (e.g., malnutrition caused by chemoradiation). In hopes of elucidating consequential deficits, a case presenting the neurocognitive profile of WE in a 71-year-old female cancer survivor is reported. Patient underwent standard chemoradiation for squamous cell carcinoma of the oropharynx in 2021 followed by frequent nutritional deficiency resulting from decreased appetite, mouth sores, and nausea/vomiting. She developed increased weakness, confusion, difficulty walking, nystagmus, and altered mental state. Completion of chemoradiation and onset of WE saw her experience altered mental status, confusion, gait instability, dysarthric speech, and memory difficulties. Imaging indicated a linear chronic infarct in the left cerebellar hemisphere and frontal predominant brain volume loss. Patient was referred for neuropsychological evaluation after beginning treatment for WE and psychotherapy to assess barriers to improving nutrition. Primary deficits were observed on verbal learning and memory, verbal fluency, executive functioning, attention, and visuomotor functioning. Comprehension and visual memory skills were intact. Both basic and higher order cognitive processes were impacted resulting in declining quality of life and activities of daily living. This study highlights the need to consider chemoradiation as an etiological risk factor for the development of WE and associated neurocognitive sequelae. Neuropsychological dysfunction is an important consideration given the acute nature of this life-threatening disease. The key elements in treatment involve thiamine replacement, nutrition, appropriate rehabilitation, and medical follow-up.