J Korean Neuropsychiatr Assoc.  2007 May;46(3):267-270.

Wernicke Encephalopathy in a Patient with Long-Standing Vomiting after Pancreatoduodenectomy

• Park WY
• Kim SW
• Lee SY
• Shin IS
• Kim JM
• Park KH
• Yang SJ
• Yoon JS

Abstract

Wernicke encephalopathy is an acute neurologic disorder attributable to thiamine (vitamin B1) deficiency. We report the case of a 61-year-old female patient who presented Wernicke encephalopathy after surgery for pancreatic head cancer. From the ninth postoperative day, she had suffered from nausea and vomiting and had difficulties ingesting food, she was given total parenteral nutrition (TPN), but lacked adequate vitamin (thiamine) supplementation. After 28 days, she developed ataxia, ophthalmoplegia, and mental confusion. The magnetic resonance image showed pathologic changes in the medial thalamus, periaqueductal gray matter, medulla and mamillary bodies. The blood level of thiamine was very low. After intravenous and oral supplementation of thiamine (200 mg/day), consciousness was soon normalized and neurologic symptoms have gradually been improving. Nausea and vomiting disappeared after administration of a low dose of mirtazapine (7.5 mg/day). We emphasize the importance of thiamine supplementation to the patients who suffer from vomiting which hinders them from taking food and who require prolonged TPN.

Keyword

Wernicke encephalopathy; Vomiting; TPN; Thiamine; Mirtazapine

MeSH Terms

Ataxia
Consciousness
Female
Head and Neck Neoplasms
Humans
Mamillary Bodies
Middle Aged
Nausea
Nervous System Diseases
Neurologic Manifestations
Ophthalmoplegia
Pancreaticoduodenectomy*
Parenteral Nutrition, Total
Periaqueductal Gray
Thalamus
Thiamine
Vitamins
Vomiting*
Wernicke Encephalopathy*
Thiamine
Vitamins