Abstract
BackgroundWernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine (vitamin B1) deficiency, frequently associated with chronic alcoholism and total parenteral nutrition without thiamine. However, only a few reports have focused on the relationship between WE and subtotal stomach-preserving pancreatoduodenectomy (SSPPD).Case presentationA 71-year-old woman underwent SSPPD for an adenocarcinoma of the ampulla of Vater. Although there had been no evidence of recurrence, the patient was treated with antibiotics for cholangitis at 12 and 31 months, respectively, post-surgery. Thereafter, the patient presented with vomiting and disorientation 33 months after surgery. Although she was admitted and underwent closer inspection by a neurologist and a psychiatrist, the exact cause of these syndromes remained unknown. The psychiatrist measured thiamine concentration to examine the cause of disorientation. After 6 days, her level of consciousness worsened. Magnetic resonance imaging of the head showed symmetrically multiple abnormal hyperintense signals on fluid-attenuated inversion-recovery and diffusion weighted image, compatible with WE. An administration of intravenous thiamine was immediately initiated. After 8 days of the measurement of the thiamine level, the patient’s serum thiamine level was found to be 6 µg/mL (reference range, 24–66 µg/mL). Accordingly, the patient was diagnosed with WE. Shortly after starting the treatment, blood thiamine value reached above normal range with significant improvement of her confusional state. However, short-term memory and ataxia remained.ConclusionsDevelopment of WE after SSPPD is uncommon. However, to prevent an after-effect, the possibility of development of WE after SSPPD should be recognized.
Highlights
Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine deficiency, frequently associated with chronic alcoholism and total parenteral nutrition without thiamine
Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine deficiency, leading to significant morbidity and mortality
WE is frequently associated with chronic alcoholism and total parenteral nutrition without thiamine [2]
Summary
Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine (vitamin B 1) deficiency, leading to significant morbidity and mortality. Laboratory data demonstrated that albumin and lymphocyte were 4.0 g/dL and 2050/μL, respectively, not suggesting malnutrition After that, she had less oral intake than preoperative intake in addition to fasting for a month in total due to recurrent cholangitis. She was treated twice with antibiotics for cholangitis at 12 and 31 months, respectively, post-surgery She had lost 8 kg compared to preoperative body weight at the first cholangitis, whereas hypoalbuminemia (3.0 g/dL) and lymphopenia (820/μL) were present at the second cholangitis. No specific findings were noted, including mental status despite her family complaint She had not gained weight, since the onset of cholangitis. The psychiatrist measured thiamine concentration to examine the cause of disorientation, whereas the laboratory measurement required 6–8 days She underwent the treatment for hyponatremia until the results of thiamine value came.
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