Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff Syndrome) among inpatients with cancer: A series of 18 cases Journal Article

Authors: Isenberg-Grzeda, E.; Alici, Y.; Hatzoglou, V.; Nelson, C.; Breitbart, W.
Article Title: Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff Syndrome) among inpatients with cancer: A series of 18 cases
Abstract: Background: Wernicke-Korsakoff Syndrome (WKS) is a neuropsychiatric syndrome caused by thiamine deficiency. Cancer predisposes to thiamine deficiency through various mechanisms. Although many case reports exist on nonalcoholic WKS in cancer, larger qualitative studies are lacking. Method: Retrospective study of patients admitted to a cancer hospital and diagnosed with WKS during routine care on a psychiatric consultation service. Only patients with at least 1 additional supporting feature (magnetic resonance imaging findings, low serum thiamine concentrations, or response to treatment) were included. Data pertaining to demographics, risk factors, phenomenology, and outcomes were abstracted from medical records by chart review. Results: In all, 18 patients were included. All patients developed WKS during cancer treatment. Hematologic malignancy, gastrointestinal tract tumors, low oral intake, and weight loss were common risk factors. All patients presented with cognitive dysfunction, most commonly impaired alertness, attention, and short-term memory. All were diagnosed by operational criteria proposed by Caine et al., 1997 (where 2 of the following are required: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment). Few exhibited Wernicke's classic triad. Diagnostic and treatment delay were common. Only 3 patients recovered fully. Conclusion: Nonalcoholic WKS can occur during cancer treatment and manifests clinically as delirium. Diagnosis should be made using operational criteria, not Wernicke's triad. Most patients were not underweight and had normal serum concentration of vitamin B12 and folate. A variety of mechanisms might predispose to thiamine deficiency and WKS in cancer. Given the high frequency of residual morbidity, studies should focus on decreasing diagnostic and treatment delay. © 2016 The Academy of Psychosomatic Medicine.
Journal Title: Psychosomatics
Volume: 57
Issue: 1
ISSN: 0033-3182
Publisher: Elsevier Science, Inc.  
Date Published: 2016-01-01
Start Page: 71
End Page: 81
Language: English
DOI: 10.1016/j.psym.2015.10.001
PROVIDER: scopus
PUBMED: 26791514
PMCID: PMC4979979
Notes: Article -- Export Date: 3 March 2016 -- Source: Scopus
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MSK Authors
  1. Yesne Alici
    44 Alici
  2. William S Breitbart
    344 Breitbart
  3. Christian Nelson
    258 Nelson