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Nutritional Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Chelsea Kesty, Madeline Hooper, Erin McClure, Emily Chea, Cynthia Bartus
Course: Early recognition and treatment of beriberi results in a favorable prognosis; nerve and cardiac function is responsive to thiamine supplementation. Wernicke encephalopathy is usually reversible with prompt therapy; however, Korsakoff-related changes are irreversible.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Wernicke encephalopathy is caused by thiamine (vitamin B1) deficiency and is typically seen in alcoholics or those who self-neglect. It presents with the classic triad of confusion, ataxia and ophthalmoplegia. Korsakoff psychosis is the chronic form of the condition and is characterised by confabulation and memory loss. MRI findings include symmetrical high signal on T2 and FLAIR sequences with post-contrast enhancement in the mammillary bodies, basal ganglia, paraventricular/medial thalamic regions, brain stem and periaqueductal grey matter. Korsakoff syndrome is associated with mammillary body atrophy and dilatation of the third ventricle.
Introduction to dementia
Published in Joanne Brooke, Dementia in Prison, 2020
The symptoms of Wernicke’s encephalopathy can include disorientation, confusion or mild memory loss, undernutrition, involuntary jerky eye movements or paralysis of the muscles that move the eyes, poor balance or unsteadiness or other difficulties with coordinating movement (Oudman et al., 2014). If Wernicke’s encephalopathy is suspected, immediate high doses of thiamine (and other B vitamins) via injection is required; prompt treatment will reverse most symptoms in a few days (Oudman et al., 2014). When Wernicke’s encephalopathy is untreated, or is not treated in a timely manner, Korsakoff’s syndrome develops gradually. Damage occurs in several regions of the brain including the thalamus and hypothalamus, and the cerebellum and amygdala resulting in severe loss of short-term day-to-day memory. Several other abilities may remain intact, such as working memory which is information that can be held for a short time period of time before using it (Oudman et al., 2014).
A case of dry beriberi from alcohol use disorder and disordered eating
Published in Substance Abuse, 2022
Kimberly Sycks, Steffen Simerlink, Lucas McKnight, Vincenzo Trovato
This patient’s excessive alcohol consumption coupled with a diet of unenriched carbohydrates explains her thiamin deficiency. Furthermore, hypomagnesemia related to alcohol use inhibits the conversion of thiamin to TPP. The patient’s diarrhea was likely an indicator of her malnutrition secondary to excessive alcohol use (fat malabsorption) as well as an additional exacerbator of her neurologic sequalae. A lack of medical insurance and access to healthcare likely led to increased symptom severity at presentation. While not present here, Wernicke’s encephalopathy is a common complication of thiamin deficiency in developed countries and is classically associated with chronic alcohol use. Although most cases of dry beriberi are attributable to bariatric surgery or total parenteral nutrition, it should remain in the differential in the setting of substance use disorder, even in an otherwise healthy adult and in the absence of Wernicke’s encephalopathy. We hope reviewing the unusual details of this case leads to the timely diagnosis and treatment of dry beriberi in the future.
Peripapillary Retinal Haemorrhages in Wernicke’s Encephalopathy Following Bariatric Surgery in a Young Patient
Published in Neuro-Ophthalmology, 2022
Motazz A. Alarfaj, Nada H. Almadhi, Mohammad Al-Amry, Abdullah I. Almater, Majed Al-Obailan
Vitamin B1, or thiamine, is a water-soluble vitamin that functions as a cofactor for energy production. There is a limited intracellular reserve so constant cellular resupply is needed.1 Thiamine deficiency can manifest with two clinical phenotypes: Wernicke-Korsakoff’s syndrome and beriberi. Wernicke’s encephalopathy is characterised classically by a triad of ophthalmoplegia, confusion, and ataxia. Korsakoff’s syndrome (KS) occurs as a late complication of WE and is defined by memory impairment associated with confabulation. KS has a mortality rate of 20% if left untreated. Beriberi may present with congestive cardiac failure (wet beriberi) or polyneuropathy (dry beriberi).1 WE can occur in the setting of poor nutrition or absorption, for example, after bariatric surgery. Whenever there is clinical suspicion, thiamine replacement should be started immediately because of the cognitive consequences of any delay. Herein, we describe a case of WE following laparoscopic sleeve gastrectomy in a young male patient who presented with binocular horizontal diplopia and was found to have preretinal peripapillary haemorrhages.
Thiamine administration to all patients with alcohol use disorder: why not?
Published in The American Journal of Drug and Alcohol Abuse, 2021
Roberta Agabio, Lorenzo Leggio
The guidelines for the prevention and treatment of Wernicke’s encephalopathy explicitly indicate the need for rapid administration of high doses of parenteral thiamine (100 to 1500 mg per day, possibly in multiple doses per day), until the patient’s improvement is observed (2–4). Unfortunately, there is no specific routine laboratory test available to assess thiamine deficiency; the direct measurement of thiamine and/or its phosphorylated forms (e.g., thiamine diphosphate, which represents about 80% of the total body content of thiamine) do not assess thiamine metabolic function and there are no universally accepted cutoff values for thiamine deficiency (7). Therefore, Wernicke’s encephalopathy remains primarily a clinical-based diagnosis (5). Nonetheless, in addition to the clinical evaluation, magnetic resonance imaging (MRI) may have an important role in confirming the clinical diagnosis of Wernicke’s encephalopathy, as it presents with peculiar neuroimaging findings (8). Perhaps more relevant, and as reviewed in Sullivan and Pfefferbaum (9), once the clinical diagnosis is made, MRI may be helpful in assessing the resolution of Wernicke’s encephalopathy in patients receiving thiamine treatment or its worsening and progression to Korsakoff’s psychosis in those without treatment.