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KMID : 0368820070460030267
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Journal of the Korean Neuropsychiatr Association
2007 Volume.46 No. 3 p.267 ~ p.270
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Wernicke Encephalopathy in a Patient with Long-Standing Vomiting after Pancreatoduodenectomy
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Park Woo-Young
Kim Sung-Wan
Lee Sam-Yeon
Shin Il-Seon
Kim Jae-Min
Park Kee-Hyung
Yang Su-Jin
Yoon Jin-Sang
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Abstract
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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.
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KEYWORD
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Wernicke encephalopathy, Vomitting, TPN, Thiamine, Mirtazapine
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