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NEUROIMAGE
Year : 2012  |  Volume : 60  |  Issue : 4  |  Page : 453-454

A case of hemorrhagic Wernicke's encephalopathy following gastric surgery


1 Department of Neurology, Catholic University of Sacred Heart, Rome, Italy
2 Department of Surgical Sciences, Section of General Surgical Clinics and Surgical Therapy, Parma University Medical School, Parma, Italy

Date of Web Publication6-Sep-2012

Correspondence Address:
Rosaria Renna
Department of Neurosciences, Institute of Neurology, Catholic University of Sacred Heart, Largo Gemelli, Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.100742

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How to cite this article:
Renna R, Plantone F, Plantone D. A case of hemorrhagic Wernicke's encephalopathy following gastric surgery. Neurol India 2012;60:453-4

How to cite this URL:
Renna R, Plantone F, Plantone D. A case of hemorrhagic Wernicke's encephalopathy following gastric surgery. Neurol India [serial online] 2012 [cited 2021 May 6];60:453-4. Available from: https://www.neurologyindia.com/text.asp?2012/60/4/453/100742


A 65-year-old Caucasian woman underwent partial gastrectomy for gastric cancer. After 3 days she developed massive hematemesis and hyperemesis. Blood tests revealed acute anemia requiring blood transfusion. One week after total parenteral nutrition she developed altered consciousness and tetraparesis. Magnetic resonance imaging (MRI) of the brain showed abnormalities typical of Wernicke's encephalopathy (WE) in association with hemorrhage of hypothalamus and thalami [Figure 1]. Despite intravenous administration of thiamine (vitamin B1), her clinical status worsened, she became comatose and died of infectious complications.
Figure 1: Brain MRI, Axial T2-fluid-attenuated inversion recovery images show abnormal high signal in periaqueductal gray matter and colliculi (arrows on a) and mesial thalami (arrows on b). Axial T2*-weighted
gradient-recalled-echo image shows hemorrhage involving both thalami (arrows on c)


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WE is a neuropsychiatric disorder due to depletion of intracellular thiamine levels in the neurons. [1] It is a well known complication of gastrointestinal surgery, especially bariatric surgery. [2] MRI usually shows symmetric alterations localized in the thalami, mamillary bodies, tectal plate, and periaqueductal area, but hyperintense signal changes also in the cerebellum, cerebral cortex, cranial nerve nuclei, red nuclei, caudate nuclei, and splenium have been reported. [3] Moreover, while microscopic hemorrhage is a well-documented pathological finding in WE, gross hemorrhage is not a common feature. [4] WE can be misdiagnosed because of its wide clinical and neuroradiological manifestation spectrum and it should be suspected in postoperative patients showing unexpected mental status changes. In such cases, prompt intravenous thiamine supplementation is strongly recommended.

 
  References Top

1.Sechi G, Serra A. Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6:442-55.  Back to cited text no. 1
[PUBMED]    
2.Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: A systematic review. Neurology 2007;68:807-11.  Back to cited text no. 2
[PUBMED]    
3.Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: Review of the literature. AJR Am J Roentgenol 2009;192:501-8.  Back to cited text no. 3
[PUBMED]    
4.Vortmeyer AO, Hagel C, Laas R. Haemorrhagic thiamine deficient encephalopathy following prolonged parenteral nutrition. J Neurol Neurosurg Psychiatry 1992;55:826-9.  Back to cited text no. 4
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