RESUMO
Wernicke encephalopathy, which is caused by a thiamine deficiency, occurs in 0.8-2% of the population. Only 16% present the typical triad of this disease: nystagmus, confusion and ataxia. We present the case of a postoperative patient with a one anastomosis gastric bypass with reoperation undergoing a Roux-en-Y gastric bypass that begins with confusion and nystagmus on her third postoperative day. The diagnosis of Wernicke encephalopathy is made by imaging, and vitamin B1 is administered with total improvement of nystagmus and altered state of consciousness (lethargy, bradypsychia, bradylalia).
La encefalopatía de Wernicke se produce por una deficiencia de tiamina se presenta en un 0.8-2% de la población. Solo el 16% de los casos presentan la tríada típica de esta enfermedad: nistagmo, confusión y ataxia. Presentamos el caso de una paciente operada de bypass gástrico de una anastomosis con reintervención convirtiendo a bypass gástrico en Y de Roux que en su tercer día de posoperatorio comienza con confusión y nistagmo. Se realiza por imagen el diagnóstico de encefalopatía de Wernicke se administra vitamina B1 con mejoría total del nistagmo y alteración del estado de consciencia (letargia, bradipsiquia, bradilalia).
Assuntos
Derivação Gástrica , Encefalopatia de Wernicke , Humanos , Feminino , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Tiamina/uso terapêuticoRESUMO
Las enfermedades de Marchiafava-Bignami y de Wernicke Korsakoff, se consideran complicaciones neuropsiquiátricas causadas por el consumo crónico de bebidas alcohólicas. Son encefalopatías poco frecuentes caracterizadas por una desmielinización y necrosis del cuerpo calloso, con la subsiguiente atrofia por daño en las partes bajas del cerebro (tálamo e hipotálamo). Se presenta un paciente masculino de 29 años, con antecedentes de alcoholismo, el cual acude a consulta de Oftalmología por presentar disminución de la visión del ojo derecho durante un año. Se le realizaron, tomografía simple y resonancia magnética con contraste endovenoso de cráneo, donde se observaron hallazgos radiológicos compatibles con el síndrome de Wernicke Korsakoff (ocasiona afectación de la memoria y el aprendizaje) con estigmas de Marchiafava-Bignami (enfermedad poco conocida). Es necesario el dominio de la epistemología de estas enfermedades, porque, a pesar del mal pronóstico en su forma aguda, se reportan casos con buena evolución, si se le realiza un diagnóstico y tratamiento oportunos.
Marchiafava-Bignami and Wernicke-Korsakoff diseases are considered neuropsychiatric complications caused by the chronic consumption of alcoholic beverages. They are rare encephalopathies characterized by demyelination and necrosis of the corpus callosum, with subsequent atrophy due to damage in the lower parts of the brain (thalamus and hypothalamus). We present a 29-year-old male patient with a history of alcoholism who went to the Ophthalmology consultation due to decreased vision in his right eye for a year. Simple tomography and magnetic resonance imaging with intravenous contrast of the skull were performed, observing radiological findings of Wernicke -Korsakoff syndrome (affect memory and learning) with Marchiafava-Bignami stigmata (little-known disease). Mastery of the epistemology of these diseases is necessary, because, despite the poor prognosis in its acute form, cases with good evolution are reported, if an opportune diagnosis and treatment is made.
Assuntos
Encefalopatia de Wernicke , Doença de Marchiafava-Bignami , Imageamento por Ressonância Magnética Multiparamétrica , TomografiaRESUMO
We describe a clinical case of a pregnant patient with hyperemesis gravidarum who progressed to abortion, Wernicke's encephalopathy, and Korsakoff's psychosis, all related to thiamine deficiency. The patient presented symptoms of disorientation, nonspecific limb movements, and fever, initially treated with metronidazole and ceftriaxone for suspected infected abortion. Subsequently, the patient was diagnosed with retained and infected abortion, and thiamine replacement therapy was initiated with an intravenous loading dose of 900 mg/day. During hospitalization, the patient presented with tetraparesis, nystagmus, decreased level of consciousness, anterograde and retrograde amnesia, confabulation, and aphasia. Magnetic resonance imaging showed lesions in the pons, typical of Wernicke's encephalopathy. The patient was empirically treated with acyclovir and ampicillin and showed clinical improvement. The text also provides a brief narrative review of the literature on the topic.
Descrevemos um caso clínico de uma paciente grávida com hiperêmese gravídica que evoluiu para aborto, Encefalopatia de Wernicke e Psicose de Korsakoff, ambas relacionadas à deficiência de tiamina. A paciente apresentou sintomas de desorientação, movimentos inespecíficos dos membros e febre, sendo, inicialmente, tratada com metronidazol e ceftriaxona por suspeita de aborto infectado. Posteriormente, a paciente foi diagnosticada com aborto retido e infectado e iniciou-se a reposição de tiamina com dose endovenosa de ataque de 900 mg/dia. Durante o internamento, a paciente apresentou tetraparesia, nistagmo, rebaixamento do nível de consciência, amnésia anterógrada e retrógrada, confabulação e afasia. A ressonância magnética mostrou lesões na ponte, típicas da Encefalopatia de Wernicke. A paciente foi tratada com aciclovir e ampicilina empiricamente e apresentou melhoras no quadro clínico. O texto também faz uma breve revisão narrativa da literatura sobre o tema.
Assuntos
Humanos , Feminino , Gravidez , Síndrome de Korsakoff , Hiperêmese GravídicaRESUMO
Thiamine deficiency can manifest as Wernicke encephalopathy, with the classic clinical triad of altered mental status, nystagmus, and ataxia. Although a rare diagnosis in pediatric patients within developed countries, gastrointestinal disorders that impair nutritional intake and absorption can place patients at higher risk. Rapid diagnosis and early empiric treatment of Wernicke encephalopathy is paramount due to high risk of mortality and long-term morbidity. We present a patient with intestinal failure who developed thiamine deficiency following weaning off parenteral nutrition with acute onset of vertigo-associated vomiting. In the absence of consensus guidelines for treatment dosing and duration, in both adult and pediatric populations, we review prior pediatric cases and propose a strategy for dosing with symptom-guided step-up approach to maximize treatment efficacy in a time-conscious manner.
RESUMO
Encephalopathy is one of the most frequent neurological complications of severe Coronavirus Disease 2019 (COVID-19) patients. Cytokine storm and sepsis, hypercatabolic states, the use of furosemide and dialytic therapy represent risk factors for thiamine deficiency and are also found in patients with severe COVID-19. In this retrospective case series, we report clinical and neurological findings of fifteen patients with COVID-19-associated Wernicke Encephalopathy (WE) and their response to treatment with intravenous thiamine. All patients had encephalopathy, with 67% displaying at least one additional sign of classic WE triad (ophthalmoparesis and ataxia). Two patients (13%) had the classic triad. All COVID-19 patients had significant improvement of the neurological manifestations between two to five days after intravenous thiamine administration. Eleven patients (73%) had good neurological outcome at hospital discharge and only two patients (13%) died. This case series suggests that thiamine deficiency may be an etiology of encephalopathy in severe COVID-19 patients and its treatment may represent a safety and low-cost response to reduce the neurological burden.
RESUMO
Encephalopathy has been frequently reported in patients with acute respiratory distress syndrome (ARDS) related to COVID-19, and its etiology remains undetermined. These patients display hypercatabolic state, weight loss, use of diuretics, and dialytic therapy, which represent risk factors for thiamine depletion. The diagnosis of Wernicke encephalopathy (WE) is challenging and based on risk factors for the depletion of thiamine. We reported three cases of patients with COVID-19-related WE treated with intravenous thiamine. All patients responded with immediate neurologic improvement, and two of them had accelerated ventilatory weaning. The cases reported suggest that thiamine deficiency could represent relevant etiology of COVID-19-related encephalopathy.
RESUMO
A síndrome de Wernicke-Korsakoff é uma rara encefalopatia desencadeada pela deficiência de tiamina, uma vitamina do complexo B, que atua como importante cofator de enzimas responsáveis pela manutenção da homeostase da energia cerebral. Apresentamos o caso de uma paciente de 18 anos, gestante, com diagnóstico prévio de pancreatite aguda biliar, que evoluiu à hiperêmese gravídica e à Wernicke-Korsakoff. Objetivamos, com este trabalho, chamar a atenção para a importância do diagnóstico imediato dessa síndrome diante de seu potencial em causar danos cerebrais irreversíveis, caso não tratada precocemente.
Wernicke-Korsakoff syndrome is a rare encephalopathy triggered by deficiency of thiamine, a B-complex vitamin, which acts as an important cofactor of enzymes responsible for maintaining brain energy homeostasis. We present the case of an 18-year-old pregnant woman with previous diagnosis of acute biliary pancreatitis, who developed hyperemesis gravidarum and Wernicke-Korsakoff. With this work, we aim to draw attention to the importance of the immediate diagnosis of this syndrome in view of its potential to cause irreversible brain damage if not treated early.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Deficiência de Tiamina , Encefalopatia de Wernicke/diagnóstico , Síndrome de Korsakoff/diagnóstico , Hiperêmese Gravídica , Relatos de Casos , Doenças do Sistema NervosoRESUMO
Abstract Wernicke encephalopathy (WE) is an acute neurological disorder resulting from vitamin B1 deficiency, which is common in chronic alcoholism. We report a rare case of WE due to hyperemesis gravidarum in a 25-year-old pregnant patient at 13 weeks and 5 days of gestation. Initially, the disease manifested as weakness, mental confusion, anterograde amnesia, and visual and auditory hallucinations. The diagnosis was established after the detection of suggestive findings of WE in the thalamus by magnetic resonance imaging (MRI) and a rapid improvement in the patient's clinical status subsequent to treatment with thiamine. Hyperemesis is a rare cause of WE, which makes the reported case important in the literature and reinforces the need for attention in clinical practice to rare but important complications of this common condition (hyperemesis gravidarum).
Resumo A encefalopatia de Wernicke (EW) é uma condição neurológica aguda resultada da deficiência de vitamina B1, muito comum em etilistas crônicos. Relatamos um caso de EW secundário a um quadro de hiperêmese gravídica em uma gestante de 25 anos de idade e 13 semanas e 5 dias de idade gestacional. Inicialmente essa desordem se manifestou como fraqueza, confusão mental, amnésia anterógrada, e alucinações auditivas e visuais. O diagnóstico foi estabelecido depois da detecção de achados sugestivos de EW na ressonância nuclear magnética e da melhora do quadro clínico com reposição de tiamina. A hiperêmese gravídica não é uma causa comum de EW, o que faz com que o presente relato de caso tenha importância na literatura e reforça a necessidade de atenção na prática clínica para complicações raras mas importantes desse quadro tão comum (hiperêmese gravídica).
Assuntos
Humanos , Feminino , Gravidez , Adulto , Diagnóstico Pré-Natal , Encefalopatia de Wernicke/diagnóstico , Hiperêmese Gravídica/diagnóstico , Primeiro Trimestre da Gravidez , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/diagnóstico por imagem , Imageamento por Ressonância Magnética , Diagnóstico Diferencial , Hiperêmese Gravídica/complicaçõesRESUMO
Encefalopatia de Wernicke (EW) e síndrome de realimentação (SR) são duas condições frequentemente coexistentes, subdiagnosticadas e que podem implicar prognóstico reservado após sua instalação. Sua identificação precoce representa um desafio para os intensivistas, haja vista a falta de sensibilidade e especificidade das manifestações clínicas. Apresenta-se um relato de caso de uma paciente portadora de esquizofrenia paranoide, sem histórico de abuso de álcool, que desenvolveu quadro de coma irreversível após greve de fome, sendo feito diagnóstico tardio de EW associada a SR. Descreve-se a evolução clínica e neuropsiquiátrica com o intuito de enfatizar a necessidade crucial de alta suspeição diagnóstica, com reposição vitamínica imediata, vigilância de distúrbios eletrolíticos e progressão parcimoniosa do aporte nutricional. (AU)
Wernicke encephalopathy (WE) and refeeding syndrome (RFS) are two often coexisting, underdiagnosed conditions that may involve a poor prognosis after their onset. Early identification represents a challenge for intensivists, given the lack of sensitivity and specificity of clinical manifestations. We report a case of a patient with paranoid schizophrenia, without a history of alcohol abuse, who developed irreversible coma after a hunger strike, with a late diagnosis of WE associated with RFS. The clinical and neuropsychiatric outcomes are described herein in order to emphasize the crucial need for a high diagnostic suspicion, with immediate vitamin replacement, monitoring of electrolyte disorders, and gradual progression of nutritional support. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Encefalopatia de Wernicke/diagnóstico , Coma/etiologia , Síndrome da Realimentação/diagnóstico , Inanição/complicações , Diagnóstico TardioRESUMO
Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. In adults, thiamin deficiency presents as encephalopathy, dry beriberi (with neurological signs and symptoms), or wet beriberi (with cardiovascular signs and symptoms). Thiamin deficiency can be diagnosed clinically, and all clinicians should be aware of this disease, especially in patients with risk factors for thiamin deficiency. Thiamin supplementation should be started as early as possible in patients suspected to have thiamin deficiency. Treatment is safe, inexpensive, simple, and life-saving. Diagnosis is confirmed on a positive response to treatment.
Assuntos
Deficiência de Tiamina/etiologia , Tiamina/metabolismo , Adulto , Humanos , Fatores de RiscoRESUMO
Introduction: Wernicke-Korsakoff Syndrome (WKS) is one of the most serious consequences of alcohol abuse. The cognitive impact of the pathology is derived from alcoholic neurotoxicity and thiamine deficiency, which can progress to stupor, coma and death. Objective: Performing a case study regarding an alcoholic patient bearing the WKS, and also designing a nursing care plan. Methods: It is a case study with a qualitative approach that assesses an alcoholic patient bearing the WKS. The study was performed at the Hospital Universitário Oswaldo Cruz (HUOC) in Recife, Brazil, over the period from February to March 2016. Results: We were able to identify 14 nursing diagnoses, as follows: chronic confusion/memory deficit/disturbed thought processes/ impaired verbal communication; impaired walking/risk of tumble down; self-care deficit; nutrition smaller than the needs/fatigue; excessive fluid volume/impaired tissue integrity; bleeding risk; impaired skin integrity; ineffective tissue perfusion. Conclusion: The nursing professionals have singular importance with regards to both the execution of health education actions as well as the alcoholics' treatment, thus preventing the complications of the disease
Introdução: A síndrome de Wernicke-Korsakoff (SWK) é uma das mais graves consequências do abuso de álcool. O impacto cognitivo da patologia é derivado da neurotoxicidade alcóolica e deficiência de tiamina, podendo progredir para estupor, coma e morte. Objetivo: Realizar um estudo de caso de paciente alcoolista portador de SWK e construir um plano de assistência de enfermagem. Métodos: Estudo de caso com abordagem qualitativa. O estudo foi realizado no Hospital Universitário Oswaldo Cruz (HUOC), em Recife, Brasil, fevereiro a março de 2016. Resultados: Identificamos 14 diagnósticos de enfermagem: confusão crônica/memória prejudicada/ processos do pensamento perturbados/comunicação verbal prejudicada; deambulação prejudicada/risco de quedas; déficit no autocuidado; nutrição desequilibrada menor que as necessidades/fadiga; volume excessivo de líquido/integridade tissular prejudicada; risco de sangramento; integridade da pele prejudicada; perfusão tissular ineficaz. Conclusão: A enfermagem tem especial importância na execução das ações de educação em saúde e tratamento de alcoolistas prevenindo as complicações da doença
Introducción: El síndrome de Wernicke-Korsakoff (WKS) es una de las más graves consecuencias del abuso del alcohol. El impacto de trastorno cognitivo se deriva de la neurotoxicidad alcohólica y la deficiencia de tiamina, que puede progresar a estupor, coma y muerte. Objetivo: Realizar un estudio de caso de un paciente con SWK alcohólica y construir un plan de atención de enfermería. Métodos: Un estudio de caso con enfoque cualitativo. El estudio se realizó en el Hospital Universitario Oswaldo Cruz (HUOC) en Recife, Brasil, entre febrero y marzo de 2016 Resultados: Se identificaron 14 diagnósticos de enfermería: confusión crónica/deterioro de la memoria/ procesos de pensamiento perturbados/alteración de la comunicación verbal; alteración de la deambulación/riesgo de caídas; déficit de autocuidado; la nutrición desequilibrada menos necesita/fatiga; volumen excesivo de líquido/ la integridad del tejido deteriorado; riesgo de sangrado; alteración de la integridad de la piel; la perfusión tisular ineficaz. Conclusión: La enfermería tiene especial importancia en la implementación de las iniciativas de educación en la salud y el tratamiento de alcohólicos prevención de las complicaciones de la enfermedad
Assuntos
Humanos , Masculino , Feminino , Adulto , Encefalopatia de Wernicke/enfermagem , Síndrome de Korsakoff/enfermagem , Alcoolismo/complicações , Alcoolismo/enfermagem , Alcoólicos , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/prevenção & controle , Educação em Saúde , Síndrome de Korsakoff/complicações , Síndrome de Korsakoff/prevenção & controleRESUMO
SUMMARY Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition.
Assuntos
Humanos , Feminino , Adulto , Deficiência de Tiamina/complicações , Encefalopatia de Wernicke/etiologia , Linfoma não Hodgkin/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante Autólogo , Encefalopatia de Wernicke/diagnóstico por imagem , Fatores de RiscoRESUMO
RESUMEN Introducción: La hiperémesis gravídica (HG) es una condición frecuente en el embarazo, que puede resultar en complicaciones potencialmente letales como la encefalopatía de Wernicke (EW), síndrome que al ser reconocido y tratado tardíamente puede traducirse en una alta morbi-mortalidad materna y fetal. Objetivo: Describir el primer caso de EW secundario a HG en Colombia y realizar una revisión de la literatura publicada sobre su diagnóstico y tratamiento. Materiales y métodos: Se describe un caso de EW secundario a HG en el que se brindó un manejo interdisciplinario. Se realizó una revisión de la literatura con los términos "encefalopatía de Wernicke", "hiperémesis gravídica" y "embarazo" incluyendo reportes de casos, series de casos, artículos de revisión, investigaciones originales o cartas al editor en inglés, español y francés, en donde se analizaron el método y tiempo del diagnóstico, pauta de tratamiento y estado funcional final. Resultados: Se incluyeron 69 publicaciones y se identificaron 89 casos. En 23 de ellos se presentó pérdida gestacional, sólo en el 12,4% de los casos se reportó el nivel de tiamina, de los cuales en el 90% se encontraba disminuido y de los casos en donde se reportó estado funcional final en el 5,9% la gestante falleció. Conclusión: La EW secundaria a HG es una complicación potencialmente letal. Debe sospecharse ante cualquier alteración neurológica e historia de emesis persistente. El diagnóstico y tratamiento oportuno interdisciplinario son fundamentales para disminuir el riesgo de secuelas que limitan la capacidad funcional con alto impacto en la calidad de vida.
ABSTRACT Introduction: Hyperemesis gravidarum (HG) is a frequent condition in pregnancy, which can result in potentially lethal complications such as Wernicke encephalopathy (WE), a syndrome that can be translated into a high maternal and fetal morbidity and mortality if it is recognized and treated late. Objective: To describe the first case of WE due to HG in Colombia and to review the published literature about its diagnosis and treatment. Materials and methods: We describe a case of WE due to HG with an interdisciplinary approach. A review of the literature was performed with the terms "Wernicke's encephalopathy", "hyperemesis gravidarum" and "pregnancy" including case reports, case series, review articles, original investigations or letters to the editor in English, Spanish and French, where the method and time of the diagnosis, treatment regimen and sequelae were analyzed. Results: Sixty-nine publications were included and 89 cases were identified. In 23 of them had a gestational loss, only in 12.4% of the cases the thiamine level was reported, in which 90% was diminished and in the cases where the final functional status was reported in 5.9% of the pregnant woman died. Conclusion: WE due to HG is a potentially lethal complication. In any neurological disturbance and history of persistent emesis it should be suspected. Timely interdisciplinary diagnosis and treatment are essential to reduce the risk of sequelae that limit functional capacity with a high impact on quality of life.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Encefalopatia de Wernicke/diagnóstico , Hiperêmese Gravídica/complicações , Qualidade de Vida , Deficiência de Tiamina , Complexo Vitamínico B/administração & dosagem , Encefalopatia de Wernicke/etiologia , Encefalopatia de Wernicke/tratamento farmacológicoRESUMO
PURPOSE: To describe a case of sudden onset of nystagmus in a pregnant patient with hyperemesis gravidarum. OBSERVATIONS: Sixteen days after onset of persistent nausea and uncontrollable vomiting, a 12 week pregnant woman presented up-beating nystagmus, mild memory impairment and reduced sensitivity in the lower limbs. Laboratory tests presented thiamine deficiency and magnetic resonance imaging showed bilateral medial thalami and midbrain lesions. Because of suspected Wernicke's encephalopathy, the patient was treated with thiamine replacement and significant improvement of symptoms took place. CONCLUSIONS AND IMPORTANCE: Uncontrollable vomiting can lead to malabsorption of vitamin B1 causing acute onset of nystagmus.
RESUMO
Resumen El citomegalovirus (CMV) es uno de los microorganismos oportunistas con mayor prevalencia en pacientes inmunocomprometidos, aunque su reactivación ha descendido después de la introducción de la terapia antirretroviral altamente activa (Highly Active Antiretroviral Therapy, HAART). En las coinfecciones, la encefalitis se ha reportado como una de las condiciones más frecuentes. Se presenta el caso de un paciente adulto joven con infección por virus de la inmunodeficiencia humana (HIV) que tuvo un rápido deterioro neurológico evidenciado en síntomas y signos clínicos clásicos del síndrome de Wernicke-Korsakoff y que no presentaba factores de riesgo para deficiencia de tiamina. En las imágenes de la resonancia magnética cerebral, se detectaron hallazgos típicos del síndrome, y se identificó citomegalovirus (CMV) en el líquido cefalorraquídeo. Con el tratamiento específico para el CMV, se logró el control de los síntomas, aunque hubo secuelas neurológicas que mejoraron. Este es uno de los pocos casos reportados a nivel mundial de síndrome de Wernicke secundario a encefalitis por citomegalovirus.
Abstract Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations. We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement. This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.
Assuntos
Adulto , Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por Citomegalovirus/complicações , Encefalite Viral/complicações , Síndrome de Korsakoff/etiologia , Antivirais/uso terapêutico , Insuficiência Respiratória/etiologia , Imageamento por Ressonância Magnética , Traqueostomia , Gastrostomia , Transtornos de Deglutição/cirurgia , Transtornos de Deglutição/etiologia , Ganciclovir/uso terapêutico , Líquido Cefalorraquidiano/virologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Infecções por Citomegalovirus/líquido cefalorraquidiano , Infecções por Citomegalovirus/tratamento farmacológico , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/tratamento farmacológico , Doenças do Nervo Abducente/etiologia , Citomegalovirus/isolamento & purificação , Diplopia/etiologia , Tuberculose Latente/complicaçõesRESUMO
Resumen ANTECEDENTES: la encefalopatía de Wernicke se origina por el déficit de vitamina B1 y sus características sobresalientes son: triada de confusión, ataxia y oftalmoplejia. Cuando hay déficit de memoria o aprendizaje se denomina síndrome de Wernicke-Korsakoff. CASO CLÍNICO: se comunica el caso de una paciente en su primer embarazo, de 18 semanas de gestación, con varios ingresos al hospital por hiperemesis gravídica; acudió al servicio de Urgencias por un cuadro de pérdida progresiva de fuerza en las extremidades inferiores. A los cinco días del ingreso tuvo empeoramiento del estado general. A la exploración física se identificó nistagmus horizonto-rotatorio, bilateral, espontáneo, tetraparesia flácida de predominio proximal, con arreflexia global de predominio en EEII y pérdida de tono de los esfínteres. La paciente se encontraba confusa, desorientada y repetitiva en su discurso. Se inició tratamiento con tiamina parenteral, por sospecha de polineuropatía metabólica por déficit de tiamina; el nistagmus y el cuadro de confusión disminuyeron. Un mes más tarde se programó para tratamiento intensivo de rehabilitación. La evolución del embarazo trascurrió con normalidad y continuó en tratamiento con tiamina y antieméticos, con estabilidad y control del cuadro. CONCLUSIÓN: la encefalopatía de Wernicke es una padecimiento de frecuencia excepcional, pero de consecuencias muy graves; de ahí la importancia de tenerlo en mente en pacientes embarazadas susceptibles de padecerlo y poner en práctica las medidas de profilaxis adecuada que eviten su aparición y las secuelas.
Abstract BACKGROUND: Wernicke's encephalopathy, caused by vitamin B1 deficiency, is characterised by the triad of confusion, ataxia and ophthalmoplegia. If memory or learning deficits appear simultaneously, it is known as Wernicke-Korsakoff syndrome. CLINICAL CASE: We present the case of a primigravida in her 18th week of pregnancy who had been suffering from hyperemesis gravidarum. She came to the emergency unit because of progressive loss of strength in her lower limbs. Five days after her admission, a deterioration of her general condition was observed. The examination revealed bilateral spontaneous horizontal-rotatory nystagmus, flaccid tetraparesis with proximal predominance, global areflexia predominantly in the lower limbs and loss of sphincters tone. The patient was confused, disoriented and repetitive in her speech. Parenteral vitamin B1 was initiated as a metabolic polineuropathy due to thiamine insufficiency was suspected. As a result the symptoms of nystagmus and confusion subsided. Intensive physical therapy was programmed in a rehabilitation unit 1 month later. Pregnancy developed normally and she continued with thiamine and antiemetic therapy. CONCLUSIONS: Wernicke's encephalopathy is an infrequent pathology, but its consequences may be really serious. This is the reason why it is paramount to take into account this entity in pregnant women liable to develop it and to carry out adequate prophylaxis to prevent its appearance and development of posterior sequels.
RESUMO
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves many organs and systems. Nervous system involvement in SLE encompasses neurological and psychiatric disorders, and remains a diagnostic and therapeutic challenge. Wernicke's encephalopathy (WE) is a neurological disorder that occurs as a consequence of thiamine deficiency, and its clinical presentation resembles the neuropsychiatric events attributed to SLE (NPSLE). Differentiation between these two entities is crucial because their treatment differs greatly and can change prognosis. We describe three cases of patients with SLE who presented with initial clinical findings suggestive of NPSLE that, at the end of a thorough clinical investigation, were actually found to represent WE. In all of these cases, treatment with thiamine resulted in significant improvement. WE should be considered as a differential diagnosis in SLE patients with neuropsychiatric signs and symptoms, especially when risk factors for thiamine deficiency are present.
Assuntos
Imagem de Difusão por Ressonância Magnética , Lúpus Eritematoso Sistêmico/diagnóstico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/diagnóstico , Encefalopatia de Wernicke/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Vasculite Associada ao Lúpus do Sistema Nervoso Central/psicologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tiamina/uso terapêutico , Resultado do Tratamento , Complexo Vitamínico B/uso terapêutico , Encefalopatia de Wernicke/complicações , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/psicologiaRESUMO
Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations.We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement.This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por Citomegalovirus/complicações , Encefalite Viral/complicações , Síndrome de Korsakoff/etiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Doenças do Nervo Abducente/etiologia , Adulto , Antivirais/uso terapêutico , Líquido Cefalorraquidiano/virologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/líquido cefalorraquidiano , Infecções por Citomegalovirus/tratamento farmacológico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Diplopia/etiologia , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/tratamento farmacológico , Ganciclovir/uso terapêutico , Gastrostomia , Humanos , Tuberculose Latente/complicações , Imageamento por Ressonância Magnética , Masculino , Insuficiência Respiratória/etiologia , TraqueostomiaRESUMO
La psicosis de Korsakoff (PK) es una de las causas más frecuentes de amnesia. Se caracteriza por confusión mental, deterioro de la memoria reciente y confabulación. Se presenta el caso de un paciente masculino de 53 años de edad, fumador de un paquete al día, durante más de 35 años, bebedor de riesgo, con antecedentes de hipertensión arterial e hipercolesterolemia. Se diagnosticó como psicosis de Korsakoff debido al déficit de tiamina o vitamina B1. La psicosis de Korsakoff es un síndrome amnésico que puede presentarse precedido o no de encefalopatía de Wernicke (EW), por lo que se diagnostican menos casos de los que en realidad existen. Por ello, es un problema frecuentemente infradiagnosticado en los centros de salud lo que resulta interesante el conocimiento de esta patología (AU).
Korsakoff psychosis is one of the most frequent causes of amnesia. It is characterized by mental confusion, impairment of the recent memory and confabulation. It is presented the case of a male patient, aged 53 years, who smoked 1 packet of cigarettes a day during more than 35 years, risk drinker with antecedents of arterial hypertension and hypercholesterolemia. He was diagnosed as Korsakoff psychosis due to the thiamine or B1 vitamin deficit. Korsakoff psychosis is an amnesic syndrome that may be preceded or not by Wernicke encephalopathy, so there are diagnosed fewer cases than those truly existing. That is why it is a problem frequently underdiagnosed in health care institutions, making interesting this disease´s knowledge (AU).
Assuntos
Humanos , Masculino , Feminino , Encefalopatia de Wernicke/epidemiologia , Síndrome de Korsakoff/epidemiologia , Encefalopatia de Wernicke/diagnóstico , Síndrome de Korsakoff/complicações , Síndrome de Korsakoff/diagnóstico , Síndrome de Korsakoff/genética , Síndrome de Korsakoff/patologia , Transtorno Amnésico Alcoólico/diagnóstico , Transtorno Amnésico Alcoólico/reabilitação , Transtorno Amnésico Alcoólico/epidemiologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologiaRESUMO
ABSTRACT We present a case report of motor and cognitive disorders in a 36-year-old woman with a history of twelve years of heavy alcohol abuse. The patient presented depressive symptoms over the course of one year after a loss in the family, evolving with ataxia, bradykinesia and choreiform movements. Progressive cognitive decline, sleep alterations and myalgia were also reported during the course of disease evolution. Physical examination revealed spastic paraparesis with fixed flexion of the hips and knees with important pain upon extension of these joints. Initial investigation suggested the diagnosis of thiamine deficiency by brain magnetic resonance imaging (MRI).
RESUMO Um relato de caso de transtornos motor e cognitivo em uma mulher de 36 anos, com história de doze anos de abuso de álcool. A paciente apresentou sintomas depressivos ao longo de um ano após uma perda na família, evoluindo com ataxia, bradicinesia e movimentos coreiformes. O declínio cognitivo progressivo, alterações do sono e mialgia também foram relatados durante o curso da evolução da doença. O exame físico demonstrou paraparesia espástica com flexão fixa dos quadris e joelhos com dor importante na extensão dessas articulações. A investigação inicial sugeriu o diagnóstico de deficiência de tiamina por ressonância magnética cerebral (MRI).