Cancer Res Treat.  2010 Jun;42(2):77-81.

Wernicke's Encephalopathy in Advanced Gastric Cancer

• Jung ES
• Kwon O
• Lee SH
• Lee KB
• Kim JH
• Yoon SH
• Kim GM
• Jeung HC
• Rha SY

Abstract

PURPOSE
With their prolonged survival and malnutrition, cancer patients, and especially gastrointestinal (GI) tract cancer patients, can develop Wernicke's encephalopathy (WE). The aim of this study is to remind physicians of the importance of WE and prompt management in patients with GI tract cancer.
MATERIALS AND METHODS
This study is a retrospective review of 2 cases of WE in advanced gastric cancer (AGC) patients, and we review the literature for cases of GI tract cancer related to WE.
RESULTS
A 48-year-old female with AGC presented dizziness and diplopia for 5 days and a 20 kg weight loss. Neurologic exam showed nystagmus and gaze disturbance. Her symptoms improved after daily parenteral injection of thiamine 100 mg for 17 days. A 58-year-old female with AGC presented with sudden disorientation, confusion and 15 kg weight loss. Neurologic exam showed gaze limitation and mild ataxia. Despite daily parenteral injection of thiamine 100 mg for 4 days, she died 5 days after the onset of neurologic symptoms. Combining the cases noted in the literature review with our 2 cases, the 7 gastric cancer cases and 2 colorectal cancer cases related to WE showed similar clinical characteristics; 1) a history of long-period malnutrition and weight loss, 2) relatively typical neurologic signs and symptoms and 3) specific magnetic resonance image findings. Except for 2 patients who had irreversible neurologic symptoms, the other 7 patients were improved with prompt thiamine treatment.
CONCLUSION
It is important to consider WE in GI tract cancer patients with acute neurologic symptoms and who are in a state of malnutrition. Thiamine should be given as soon as possible when WE is suspected.

Keyword

Wernicke's encephalopathy; Advanced gastric cancer; Thiamine

MeSH Terms

Ataxia
Colorectal Neoplasms
Diplopia
Dizziness
Female
Gastrointestinal Tract
Humans
Magnetic Resonance Spectroscopy
Malnutrition
Middle Aged
Neurologic Manifestations
Retrospective Studies
Stomach Neoplasms
Thiamine
Weight Loss
Wernicke Encephalopathy
Thiamine

Figure

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  Fig. 1 (A) Bilateral symmetric signal increase at the midbrain. (B) Bilateral symmetric signal increase at the medial part of the thalami (Flair MRI).

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  Fig. 2 (A) High signal lesion around the hypothalamus. (B) High signal lesion at the medial part of the thalami (T2WI MRI).

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