Wernicke's encephalopathy associated with hemodialysis: report of two cases and review of the literature.

Two rare cases of Wernicke's encephalopathy (WE) in non-alcoholic patients on hemodialysis (HD) are reported. They presented with the clinical triad of WE (ophthalmoplegia, ataxia and disturbance of consciousness) and intravenous administration of thiamine led to complete elimination of these manifestations. Reduced plasma thiamine levels prior to the administration confirmed the diagnosis of WE. Interestingly, a reduction in plasma thiamine levels by about half was seen in one of the patients on HD, suggesting that thiamine, a water-soluble vitamin, can be depleted with HD. In the literature, nine HD-dependent patients have been reported to develop WE, seven of whom were diagnosed postmortem. Their premortem diagnoses included uremic encephalopathy, dysequilibrium syndrome and dialysis dementia, which can often complicate HD and present symptoms similar to those of WE. We therefore emphasize that WE, even though a rare complication, should be suspected in all patients on HD who present with at least one of the clinical triad of WE.     

Associations between retrospective versus ecological momentary assessment measures of emotion and eating disorder symptoms in anorexia nervosa

This study examined the unique associations between eating disorder symptoms and two emotion-related constructs (affective lability and anxiousness) assessed via distinct methodologies in anorexia nervosa (AN). Women (N = 116) with full or subthreshold AN completed baseline emotion and eating disorder assessments, followed by two weeks of ecological momentary assessment (EMA). Hierarchical regressions were used to examine unique contributions of baseline and EMA measures of affective lability and anxiousness in accounting for variance in baseline eating disorder symptoms and EMA dietary restriction, controlling for age, body mass index, depression, and AN diagnostic subtype. Only EMA affective lability was uniquely associated with baseline eating disorder symptoms and EMA dietary restriction. Anxiousness was uniquely associated with baseline eating disorder symptoms regardless of assessment method; neither of the anxiousness measures was uniquely associated with EMA dietary restriction. Affective lability and anxiousness account for variance in global eating disorder symptomatology; AN treatments targeting these emotion-related constructs may prove useful.     

Treatment of Wernicke’s encephalopathy with high dose of thiamine in a patient with pyloric sub-stenosis: description of a case

Wernicke’s encephalopathy (WE) is an acute or subacute syndrome that results from a deficiency in vitamin B1 (thiamine). The syndrome is characterised by a classical triad of symptoms: nystagmus and ophthalmoplegia, mental-status changes, and unsteadiness of stance and gait. When patients with WE are inappropriately treated with low doses of thiamine, mortality rates average out at 20% and Korsakoff’s Psychosis develops in about 85% of survivors (Sechi and Serra in Lancet Neurol 6(5):442–455, 2007). We report the case of a patient with a pyloric sub-stenosis that developed a WE, and was treated with high doses of thiamine showing after few days of treatment a great improvement of neurological and neuroradiological assessment, even though cognitive impairment was still severe at discharge and at 6 months follow-up.     

Wernicke encephalopathy after subtotal gastrectomy for morbid obesity

Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.     

Wernicke脑病综合征10例临床分析

目的:探讨Wernicke脑病(WE)的病因、临床表现特点、MRI表现及预后。方法:对10例WE患者的病因、临床表现、头颅MRI特点和预后进行了回顾性分析。结果:WE病因多与维生素B1缺乏有关,主要临床表现为眼肌麻痹,共济失调、精神异常三联症,但也可以表现为周围神经病、言语障碍等。头颅MRI有特异性部位的异常信号改变。及时予以维生素B1治疗者预后多良好。结论:提高临床对WE的认识,有利于早诊断、早干预,有助于改善WE的预后。     

An examination of cognitive versus behavioral components of recovery from anorexia nervosa

Definitions of "full recovery" from anorexia nervosa (AN) vary, and rarely include the cognitive criteria of lack of body image distortion and fear of weight gain. We investigated the implications of including or excluding cognitive criteria of AN in the definition of "full recovery". Current symptomatology and personality characteristics associated with AN were assessed and compared in 42 behaviorally but not cognitively recovered women, 32 both behaviorally and cognitively recovered women, and 253 controls. On all measures included, the scores of the behaviorally recovered women were significantly more anorexic-like than those of the women recovered cognitively as well, who were indistinguishable from controls. Criteria for recovery from AN need to be refined and standardized, and cognitive criteria incorporated, to characterize a minority who recover to the extent that their eating attitudes and personality profiles are indistinguishable from those of women with no history of an eating disorder.     

非酒精性Wernicke脑病二例

目的探讨Wernicke脑病患者的临床和影像学特点。方法分析2例非酒精性Wernicke脑病患者的临床资料。结果 2例患者均为消化道晚期肿瘤行手术治疗、术后有营养不均衡、发病前有葡萄糖注射液补液史。2例患者均有意识障碍和典型的头颅MRI信号改变,即双侧丘脑内侧、中脑顶盖及导水管周围的高T_2信号;维生素B_1补充治疗后患者的症状有不同程度的好转。结论导致维生素B_1缺乏的高危因素、临床表现及典型的头颅MRI表现是临床上Wernicke脑病早期诊断的重要线索。早期足量维生素B_1治疗效果好。高危患者应注意预防Wernicke脑病的发生。     

Long-term cognitive sequelae in a case of Wernicke’s encephalopathy after allogeneic stem cell transplantation

ABSTRACT

We describe the case of a non-alcoholic patient with chronic myeloid leukemia who developed iatrogenic Wernicke’s encephalopathy (WE) following stem cell transplantation. Four years after the WE acute event, the patient’s cognitive profile was mainly characterized by moderate memory impairment, and functional and daily-living difficulties. Our report sustains the hypothesis that a iatrogenic form of WE may produce long-term cognitive sequelae even when thiamine therapy is administered in the acute phase until the resolution of the neurological signs.     

EFNS guidelines for diagnosis,therapy and prevention of Wernicke encephalopathy

Background: Although Wernicke encephalopathy (WE) is a preventable and treatable disease it still often remains undiagnosed during life. Objectives: To create practical guidelines for diagnosis, management and prevention of the disease. Methods: We searched MEDLINE, EMBASE, LILACS, Cochrane Library. Conclusions and recommendations:

• 1 The clinical diagnosis of WE should take into account the different presentations of clinical signs between alcoholics and non alcoholics (Recommendation Level C); although prevalence is higher in alcoholics, WE should be suspected in all clinical conditions which could lead to thiamine deficiency (good practice point – GPP).
• 2 The clinical diagnosis of WE in alcoholics requires two of the following four signs; (i) dietary deficiencies (ii) eye signs, (iii) cerebellar dysfunction, and (iv) either an altered mental state or mild memory impairment (Level B).
• 3 Total thiamine in blood sample should be measured immediately before its administration (GPP).
• 4 MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B).
• 5 Thiamine is indicated for the treatment of suspected or manifest WE. It should be given, before any carbohydrate, 200 mg thrice daily, preferably intravenously (Level C).
• 6 The overall safety of thiamine is very good (Level B).
• 7 After bariatric surgery we recommend follow‐up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation (GPP).
• 8 Parenteral thiamine should be given to all at‐risk subjects admitted to the Emergency Room (GPP).
• 9 Patients dying from symptoms suggesting WE should have an autopsy (GPP).

     

On the role of sadness in the psychopathology of anorexia nervosa

Recent models on the development and maintenance of eating disorders propose negative emotions to be important precursors for the occurrence of eating disorder symptomatology. In fact, previous research on bulimia nervosa (BN) and binge eating disorder provides evidence that negative emotions are an antecedent condition for binge eating. However, there is a lack of research examining the influence of negative emotions on restrictive eating and exercising in individuals with anorexia nervosa (AN). In an experimental study, women with AN (n=39) and BN (n=34) as well as a non-eating disordered control group (CG; n=34) watched a sadness-inducing film clip. Before and after the film clip participants rated their current desire to engage in dietary restriction (DTR) and desire to exercise (DTE). Main results reveal that DTR significantly increased after the film clip in women with AN only, while DTE decreased over time in all groups. Results are in line with the notion that negative emotions have a prominent influence on the core eating pathology in AN.     

韦尼克脑病16例临床分析

目的探讨韦尼克脑病(Wernicke’s encephalopathy,WE)的病因、发病机制、临床表现及治疗。方法回顾性分析我院2002~2009年16例WE患者的临床资料。结果 WE病因复杂,饮酒为其最常见的病因。主要临床表现包括行走不稳、眼征、精神神志障碍三联征,但典型的WE三联征很少同时出现,往往以其中一种或两种表现为主。头部MRI大多为腔隙性脑梗死、脑萎缩等非特异性表现,丘脑、下丘脑、乳头体及脑室周围等部位对称性长T1、长T2信号的特征性表现并不多见。绝大多数患者经大剂量补充Vit-B1后疗效显著。结论 WE病因及临床表现复杂多样,早期诊断困难,头部MRI可作为WE重要的辅助检查。及时补充大剂量Vit-B1预后良好。     

Examining the associations between emotion regulation difficulties,anxiety, and eating disorder severity among inpatients with anorexia nervosa

ObjectiveThere is growing interest in the role of emotion regulation in anorexia nervosa (AN). Although anxiety is also hypothesized to impact symptoms of AN, little is known about how emotion regulation, anxiety, and eating disorder symptoms interact in AN. In this study, we examined the associations between emotion regulation, anxiety, and eating disorder symptom severity in AN.MethodsQuestionnaires and interviews assessing emotion regulation difficulties, anxiety, eating disorder symptoms, and eating disorder-related clinical impairment were collected from group of underweight individuals with AN (n = 59) at admission to inpatient treatment. Hierarchical linear regressions were used to examine the associations of emotion regulation difficulties, anxiety, and the interaction of these constructs with eating disorder symptoms and eating disorder-related clinical impairment.ResultsEmotion regulation difficulties were significantly positively associated with eating disorder symptoms and related clinical impairment only when anxiety levels were low and anxiety was significantly positively associated with eating disorder symptoms and related clinical impairment only when emotion regulation problems were not elevated.ConclusionsThis study adds to a growing literature suggesting that emotion regulation deficits are associated with eating disorder symptoms in AN. Certain individuals with AN may especially benefit from a focus on developing emotion regulation skills in the acute stages of illness.     

Wernicke脑病

Wernicke脑病（WE）是一种急性或亚急性起病的维生素B1缺乏症。表现为眼部体征、躯干性共济失调、意识障碍和情感淡漠及多发性周围神经病。M砌的表现有助于提示本病。WE是由于胃肠道手术、酗酒和胰腺炎等病因引起,补充维生素B1有助于恢复。     

Anorexia nervosa in 51 Swedish adolescents: premorbid problems and comorbidity.

Fifty-one teenage cases with anorexia nervosa (AN) were compared with 51 age-, sex-, and school-matched cases with respect to premorbid developmental, physical, and psychiatric problems and comorbidity at the time of examination. Almost half of the AN group consisted of the total population of AN cases in one birth cohort. There were more premorbid personality problems in the AN group. Obsessive compulsive problems were very common in this group, as was undue concern about physical appearance. Depressive symptoms during the course of the eating disorder were almost universal in the AN group, but it did not appear that such symptoms had preceded the eating disorder. It seems that there may be a number of subgroups with AN and that the majority of these can be better understood in the light of factors intrinsic to the patients themselves rather than in the context of deviant family interaction.     

Wernicke’s encephalopathy in a patient with acute pancreatitis: unusual cortical involvement and marvelous prognosis

Wernicke's encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency. Clinically, it is most frequently observed in people with alcohol abuse. WE, however, can occur in any clinical condition associated with malnutrition or thiamine deficiency. We present the case of a 47-year-old woman with prolonged therapeutic fasting who presented with ophthalmoplegia, ataxia and deep coma. MRI showed unusual symmetric cortical abnormalities in the frontal and parietal lobes, as well as typical lesions surrounding the third ventricle and aqueduct. Although the patient entered a vegetative state, she finally regained consciousness after thiamine supplementation unexpectedly. To the best of our knowledge, it has never been reported to date that the patient with WE in a vegetative state with cortical damage shows a marvelous prognosis, which prompts us to report this case. In the present report, we highlight the role of MRI in the diagnosis of acute WE.     

Psychobiology of borderline personality traits related to subtypes of eating disorders: a study of platelet MAO activity

Increased and decreased levers of platelet monoamine oxidase (MAO) activity have been reported in patients with eating disorders, indicating abnormalities of the serotonin turnover. However, whether these findings are related to eating disorders or are rather reflecting the pathophysiology of borderline personality traits in these patients is still unknown. Platelet MAO activity and comorbid personality disorders were investigated in 72 patients with different subtypes of eating disorders (ED) and in a group of 28 healthy controls. ED patients comprised the following subtypes: 25 anorexia nervosa (AN) restrictive, 14 AN binge eating-purging (AN b-p), 3 anorexia nervosa not otherwise specified (AN NOS) and 30 bulimia nervosa (BN). Personality disorders and traits were assessed with the Structured Interview for Personality Disorders (SCID-II), the Zanarini Rating Scale for Borderline Personality Disorder, and the Barrat Impulsiveness Scale. Platelet MAO activity was significantly lower in ED patients with comorbid borderline personality disorder (BPD) than in ED without Borderline personality disorder (BDP). Platelet MAO activity was significantly and inversely correlated with the number and severity of BPD clinical features. In the subsample of patients with binge eating-purging symptoms (AN b-p, AN NOS and BN), platelet MAO activity was significantly lower in binge-purge patients with comorbid BPD than in binge-purge patients without BPD. The whole group of eating disorders had a significantly reduced lever of platelet MAO activity compared with the control group. The results suggest that low platelet MAO activity might characterize eating disorders with comorbid borderline personality traits, reflecting greater serotonin dysfunction in these patients. The role of decreased platelet MAO as an endophenotype with specific clinical manifestations should be explored in future studies.     

Wernicke encephalopathy after gastrointestinal surgery for cancer: causes of diagnostic failure or delay

Wernicke encephalopathy (WE) is a neurological emergency due to thiamine deficiency. We aimed to identify clinical course and causes of diagnostic delay or failure of WE in a group of patients who underwent surgery for gastrointestinal tumors. A retrospective review of clinical, laboratory, neuroimaging, and therapeutic features of 10 patients with WE following abdominal surgery for cancer was carried out. Four patients died; in these subjects, diagnosis was delayed and supplementation of vitamin was absent or likely inadequate. Diagnostic delay or failure was also related to the coexistence of several medical complications at presentation masking typical symptoms of WE. In the surviving patients, outcome was influenced by promptness and type of therapy. Postoperative abdominal bleeding and number of subsequent operations may also had an effect. Postsurgical patients with gastrointestinal tumors may develop a subtle WE. The number of subsequent operations and the severity of postoperative complications may increase the risk of unrecognized WE. The disease should be suspected in postsurgical patients who have unexpected mental status changes, even under prophylactic treatment with vitamins. We suggest that prophylaxis with high doses of thiamine should be undertaken in patients with gastrointestinal tumors before surgery.     

35例韦尼克脑病临床分析

目的探讨韦尼克脑病(Wernicke’s encephalopathy,WE)的病因、临床表现、磁共振特征、误诊原因和治疗转归。方法回顾性分析我院2012年10月~2015年6月收治的35例WE患者的临床资料。结果饮酒是WE最常见原因,其次是胃、胆囊、胰腺病变导致呕吐和进食差。具有典型的精神意识障碍、眼肌麻痹、共济失调三联征者占11.4%,具备三联征中两项者占42.9%,仅有三联征中一项者占45.7%。头部MRI可见双侧丘脑、侧脑室周围、导水管周围、第三脑室、四脑室旁、乳头体、皮质、胼胝体等部位对称性异常信号。本组患者的误诊率达60%,其中酒精中毒性WE误诊率为54.17%,非酒精中毒性WE误诊率为72.73%。住院期间91.42%患者(32/35)好转,8.58%患者无好转。出院5 m时9例失访,随访的26例中6例死亡(死亡率23.07%),13例痊愈(50%),5例遗留记忆力障碍,2例完全卧床。结论 WE病因及临床表现多样,MRI有特征性改变,但早期误诊率高,预后与是否诊断和治疗及时密切相关。     

Eating Disorders,Trauma, PTSD,and Psychosocial Resources

The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (ED) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared; post-traumatic symptomatology and the role of psychosocial resources were analyzed. One hundred three ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. We found that 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources.