Abstract
Postoperatif uzun süre beslenme desteği alan bir hastada aniden ortaya çıkan tiamin (vitamin B1) eksikliğine bağlı Wernicke ensefalopatisi olgusu tariflenmiştir. Mide kanseri nedeniyle total gastrektomi yapılan 55 yaşındaki erkek hastada postoperatif gelişen intestinal fistül nedeniyle uzun süreli parenteral beslenme desteği verilirken ani başlayan konfüzyonel durum, oftalmoparezi, trunkal ataksi, hipotermi ve hipotansiyon semptomları ortaya çıkmıştır. Yapılan nörolojik değerlendirme ve manyetik rezonans incelemesi sonucu Wernicke ensefalopatisi tanısı konulmuştur. Hızla yapılan tiamin replasmanına dramatik cevap alınmış ve herhangi bir sekel kalmadan hasta taburcu edilmiştir. Cerrahi hastalarda gelişen nörolojik komplikasyonlarda, Wernicke ensefalopatisi ayırıcı tanıda düşünülmeli ve şüphelenildiğinde erken dönemde tiamin desteği sağlanmalıdır. Ayrıca parenteral beslenme solüsyonlarına rutin olarak vitamin preperatları eklenmelidir. Anahtar Kelimeler: Wernicke Ensefalopatisi; Parenteral Beslenme; Postoperatif Komplikasyon.
Keywords
References
- Victor M, Adams R, Collins G. The Wernicke-Korsakoff Syndrome and Related Neurologic disorders due to alcoholism and malnutrition. 2nd ed. Philadelphia, PA: FA Davis. 1989.
- Howell MD, Donnino M, Clardy P, Talmor D, Shapiro NI. Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med 2007;33:18929-9.
- Nakasaki H, Ohta M, Soeda J, et al. Clinical and biochemical aspects of thiamine treatment for metabolic acidosis during total parenteral nutrition. Nutrition 1997;13:110-7.
- Victor M. Deficiency diseases of the nervous system secondary to alcoholism. Postgrad Med 1971;50:75-9.
- Francini-Pesenti F, Brocadello F, Famengo S, Nardi M, Caregaro L. Wernicke’s encephalopathy during parenteral nutrition. JPEN 2007;31:69-71.
- Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty- six alcoholic and nonalcoholic patients. Am J Neuroradiol 2007;28(7):1328-31.
- Donnal JF, Heinz ER, Burger PC. MR of reversible thalamic lesions in Wernicke syndrome. AJNR 1990;11:893-4.
- Harper C, Gold J, Rodriguez M, et al. The prevalence of the Wernicke-Korsakoff syndrome in Sydney, Australia: A prospective necrops study. J Neurol NeurosurgPsychiatry 1989;52:282-5.
- Onishi H, Sugimasa Y, Kawanishi C, Onose M. Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: A case report and review of the literature. Palliat Suppot Care 2005;3:337-40.
- Francini-Pesenti F, Brocadello F, Manara R, Santelli L, Laroni A, Caregaro L. Wernicke’s syndrome during parenteral feeding: Not an unusual complication. Nutrition 2009;25:142-6
Abstract
Here we described a case of Wernicke's encephalopathy with thiamin (vitamin B1) deficiency after a prolonged postoperative parenteral nutritional. A 55-year-old male patient with total gastrectomy for gastric cancer had a postoperative intestinal fistula and required a long-term parenteral nutrition. During the treatment, he developed sudden confusional state, ophtalmoplegy, truncal ataxia, hypothermia and hypotension. Wernicke's encephalopathy was diagnosed after neurological evaluation and magnetic resonance imaging. We observed a dramatic response to thiamine replacement, his symptoms recovered quickly and the patient was discharged without any sequelae. Wernicke's encephalopathy should be considered in the differential diagnosis of the surgical patients with neurological complications, and when suspected early support of thiamine should be provided. In addition, vitamin preparations should be routinely added to solutions of parenteral nutrition. Key Words: Wernicke's Encephalopathy; Parenteral Nutrition; Postoperative Complication.
References
- Victor M, Adams R, Collins G. The Wernicke-Korsakoff Syndrome and Related Neurologic disorders due to alcoholism and malnutrition. 2nd ed. Philadelphia, PA: FA Davis. 1989.
- Howell MD, Donnino M, Clardy P, Talmor D, Shapiro NI. Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med 2007;33:18929-9.
- Nakasaki H, Ohta M, Soeda J, et al. Clinical and biochemical aspects of thiamine treatment for metabolic acidosis during total parenteral nutrition. Nutrition 1997;13:110-7.
- Victor M. Deficiency diseases of the nervous system secondary to alcoholism. Postgrad Med 1971;50:75-9.
- Francini-Pesenti F, Brocadello F, Famengo S, Nardi M, Caregaro L. Wernicke’s encephalopathy during parenteral nutrition. JPEN 2007;31:69-71.
- Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty- six alcoholic and nonalcoholic patients. Am J Neuroradiol 2007;28(7):1328-31.
- Donnal JF, Heinz ER, Burger PC. MR of reversible thalamic lesions in Wernicke syndrome. AJNR 1990;11:893-4.
- Harper C, Gold J, Rodriguez M, et al. The prevalence of the Wernicke-Korsakoff syndrome in Sydney, Australia: A prospective necrops study. J Neurol NeurosurgPsychiatry 1989;52:282-5.
- Onishi H, Sugimasa Y, Kawanishi C, Onose M. Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: A case report and review of the literature. Palliat Suppot Care 2005;3:337-40.
- Francini-Pesenti F, Brocadello F, Manara R, Santelli L, Laroni A, Caregaro L. Wernicke’s syndrome during parenteral feeding: Not an unusual complication. Nutrition 2009;25:142-6
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | February 1, 2011 |
| Published in Issue | Year 2011 Volume: 18 Issue: 1 |