J Korean Assoc Oral Maxillofac Surg.  2016 Apr;42(2):120-122. 10.5125/jkaoms.2016.42.2.120.

Wernicke's encephalopathy in a patient with masticator and parapharyngeal space abscess: a case report

• Chin YJ
• Yoon KH
• Park KS
• Park JA
• Woo MH

• KMID: 2351736
• DOI: http://doi.org/10.5125/jkaoms.2016.42.2.120

Abstract

Wernicke's encephalopathy is a fatal neurological disease caused by thiamine deficiency. Many reports indicate that Wernicke's encephalopathy is caused by malnutrition. We report the case of a 79-year-old female patient who had a left masticator space and parapharyngeal space abscess who was diagnosed with Wernicke's encephalopathy. She reported problems while eating due to the presence of the abscess, but the true quantities of food she was ingesting were never assessed. Clinicians have a responsibility to provide adequate nutritional support by ensuring that patients receive adequate nutrition. Clinicians should also keep in mind that Wernicke's encephalopathy may occur in patients who experienced prolonged periods of malnutrition.

Keyword

Wernicke encephalopathy; Malnutrition; Masticator space and parapharyngeal space abscess; Parenteral nutrition

MeSH Terms

Abscess*
Aged
Eating
Female
Humans
Malnutrition
Nutritional Support
Parenteral Nutrition
Thiamine Deficiency
Wernicke Encephalopathy*

Figure

• 

  Fig. 1 Computed tomography with contrast enahancement shows an abscess in the the left masticator space (arrows) and parapharyngeal space (dotted arrows). A. Axial view. B. Coronal view.

• 

  Fig. 2 Magnetic resonance imaging shows characteristic Wernicke's encephalopathy with T2 signal hyper-intensity in the periaqueductal area (arrow).

Reference

1. Isenberg-Grzeda E, Kutner HE, Nicolson SE. Wernicke-Korsakoff-syndrome: under-recognized and under-treated. Psychosomatics. 2012; 53:507–516. PMID: 23157990.

2. D'Ettorre M, Rosa F, Coppola A, Mele C, Alfieri S, Doglietto GB. Postoperative suspected Wernickes encephalopathy in a rectal cancer patient: a case report. J Palliat Care. 2012; 28:290–292. PMID: 23413765.

3. Chen MH, Lee JT, Peng GS, Sung YF. Non-alcoholic Wernicke's encephalopathy as a cause of profound shock after abdominal surgery. QJM. 2015; 108:661–663. PMID: 23417912.

4. Zuccoli G, Gallucci M, Capellades J, Regnicolo L, Tumiati B, Giadás TC, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuroradiol. 2007; 28:1328–1331. PMID: 17698536.

5. Larsen TR, Dragu D, Williams M. Wernicke's encephalopathy: an unusual consequence of the acquired immune deficiency syndrome--case report and literature review. Case Rep Med. 2013; DOI: 10.1155/2013/709474.

6. Elefante A, Puoti G, Senese R, Coppola C, Russo C, Tortora F, et al. Non-alcoholic acute Wernicke's encephalopathy: role of MRI in non typical cases. Eur J Radiol. 2012; 81:4099–4104. PMID: 22954409.

7. Unlu E, Cakir B, Asil T. MRI findings of Wernicke encephalopathy revisited due to hunger strike. Eur J Radiol. 2006; 57:43–53. PMID: 16085381.

8. Raziel A. Thiamine deficiency after bariatric surgery may lead to Wernicke encephalopathy. Isr Med Assoc J. 2012; 14:692–694. PMID: 23240377.

9. Lindberg MC, Oyler RA. Wernicke's encephalopathy. Am Fam Physician. 1990; 41:1205–1209. PMID: 2181837.

10. Green A, Parker R, Williams TM. A novel scoring system to guide risk assessment of Wernicke's encephalopathy. Alcohol Clin Exp Res. 2013; 37:885–889. PMID: 23278769.

11. Fang JC, Chirag DN, Dym H. Nutritional aspects of care. Oral Maxillofacial Surg Clin North Am. 2006; 18:115–130.