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Wernicke's encephalopathy after total parenteral nutrition in patients with Crohn's disease.

Shin IS, Seok H, Eun YH, Lee YB, Lee SE, Kim ER, Chang DK, Kim YH, Hong SN - Intest Res (2016)

Bottom Line: Magnetic resonance imaging allowed definitive diagnosis for WE despite poor sensitivity.The intravenous administration of thiamine alleviated the symptoms of WE dramatically.We emphasize the importance of thiamine supplementation for malnourished patients even if they are not alcoholics, especially in those with CD.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Micronutrient deficiencies in Crohn's disease (CD) patients are not uncommon and usually result in a combination of reduced dietary intake, disease-related malabsorption, and a catabolic state. Decreased serum thiamine levels are often reported in patients with CD. Wernicke's encephalopathy (WE) is a severe form of thiamine deficiency that can cause serious neurologic complications. Although WE is known to occur frequently in alcoholics, a number of non-alcoholic causes have also been reported. Here, we report two cases of non-alcoholic WE that developed in two severely malnourished CD patients who were supported by prolonged total parenteral nutrition without thiamine supplementation. These patients complained of sudden-onset ophthalmopathy, cerebellar dysfunction, and confusion. Magnetic resonance imaging allowed definitive diagnosis for WE despite poor sensitivity. The intravenous administration of thiamine alleviated the symptoms of WE dramatically. We emphasize the importance of thiamine supplementation for malnourished patients even if they are not alcoholics, especially in those with CD.

No MeSH data available.


Related in: MedlinePlus

Abdominal CT findings. (A) In the horizontal view, a lobulated abscess with an enteromesenteric fistula is noticed. (B) In the horizontal view, a multilobulated abscess in pelvic cavity is seen. (C) In the coronal view, abscess formation in the pelvic cavity is noticed. (D) In the coronal view, tubular tract between the distal ileum and abscess is noticed.
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Figure 3: Abdominal CT findings. (A) In the horizontal view, a lobulated abscess with an enteromesenteric fistula is noticed. (B) In the horizontal view, a multilobulated abscess in pelvic cavity is seen. (C) In the coronal view, abscess formation in the pelvic cavity is noticed. (D) In the coronal view, tubular tract between the distal ileum and abscess is noticed.

Mentions: An abdominal CT scan revealed enteromesenteric fistula, enteroenteric fistula, and intraabdominal abscess (Fig. 3), which were treated by fasting, high dose steroids, and antibiotics. She was also treated with peripheral TPN (Combiflex lipid peri® 1920 mL) without thiamine supplementation. After 17 days of fasting, she complained of sudden-onset dizziness and gait ataxia. The next day, her symptoms worsened and new symptoms including nausea, vomiting, and blurred vision developed. There was no organic abnormality apparent to explain her symptoms in ophthalmologic and otolaryngological examinations. Brain MRI revealed a high signalintensity lesion at the inferior colliculus of the midbrain and pontomedullary junction on a (Fig. 4), which was compatible with WE. After intravenous thiamine supplementation, her symptoms were resolved without any sequelae. Although she underwent ileocecectomy for fistula and intraabdominal abscess, her neurologic symptoms were fully resolved.


Wernicke's encephalopathy after total parenteral nutrition in patients with Crohn's disease.

Shin IS, Seok H, Eun YH, Lee YB, Lee SE, Kim ER, Chang DK, Kim YH, Hong SN - Intest Res (2016)

Abdominal CT findings. (A) In the horizontal view, a lobulated abscess with an enteromesenteric fistula is noticed. (B) In the horizontal view, a multilobulated abscess in pelvic cavity is seen. (C) In the coronal view, abscess formation in the pelvic cavity is noticed. (D) In the coronal view, tubular tract between the distal ileum and abscess is noticed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4863055&req=5

Figure 3: Abdominal CT findings. (A) In the horizontal view, a lobulated abscess with an enteromesenteric fistula is noticed. (B) In the horizontal view, a multilobulated abscess in pelvic cavity is seen. (C) In the coronal view, abscess formation in the pelvic cavity is noticed. (D) In the coronal view, tubular tract between the distal ileum and abscess is noticed.
Mentions: An abdominal CT scan revealed enteromesenteric fistula, enteroenteric fistula, and intraabdominal abscess (Fig. 3), which were treated by fasting, high dose steroids, and antibiotics. She was also treated with peripheral TPN (Combiflex lipid peri® 1920 mL) without thiamine supplementation. After 17 days of fasting, she complained of sudden-onset dizziness and gait ataxia. The next day, her symptoms worsened and new symptoms including nausea, vomiting, and blurred vision developed. There was no organic abnormality apparent to explain her symptoms in ophthalmologic and otolaryngological examinations. Brain MRI revealed a high signalintensity lesion at the inferior colliculus of the midbrain and pontomedullary junction on a (Fig. 4), which was compatible with WE. After intravenous thiamine supplementation, her symptoms were resolved without any sequelae. Although she underwent ileocecectomy for fistula and intraabdominal abscess, her neurologic symptoms were fully resolved.

Bottom Line: Magnetic resonance imaging allowed definitive diagnosis for WE despite poor sensitivity.The intravenous administration of thiamine alleviated the symptoms of WE dramatically.We emphasize the importance of thiamine supplementation for malnourished patients even if they are not alcoholics, especially in those with CD.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Micronutrient deficiencies in Crohn's disease (CD) patients are not uncommon and usually result in a combination of reduced dietary intake, disease-related malabsorption, and a catabolic state. Decreased serum thiamine levels are often reported in patients with CD. Wernicke's encephalopathy (WE) is a severe form of thiamine deficiency that can cause serious neurologic complications. Although WE is known to occur frequently in alcoholics, a number of non-alcoholic causes have also been reported. Here, we report two cases of non-alcoholic WE that developed in two severely malnourished CD patients who were supported by prolonged total parenteral nutrition without thiamine supplementation. These patients complained of sudden-onset ophthalmopathy, cerebellar dysfunction, and confusion. Magnetic resonance imaging allowed definitive diagnosis for WE despite poor sensitivity. The intravenous administration of thiamine alleviated the symptoms of WE dramatically. We emphasize the importance of thiamine supplementation for malnourished patients even if they are not alcoholics, especially in those with CD.

No MeSH data available.


Related in: MedlinePlus