Pancreatic encephalopathy and Wernicke encephalopathy in association with acute pancreatitis: a clinical study.
OBJECTIVE
To investigate clinical characteristics and therapy of pancreatic encephalopathy (PE) and Wernicke encephalopathy (WE).


METHODS
In a retrospective study of 596 patients with acute pancreatitis (AP), patients with PE were compared to those with WE in regards to history, clinical manifestation, diagnosis, treatment and outcome.


RESULTS
There were 93 patients with severe acute pancreatitis (SAP). Encephalopathies were discovered in 10 patients (1.7%). Six patients with PE all developed in SAP (6.5%), and three of them died (3% of SAP, 50% of PE). Four patients with WE developed in AP (0.7%), and two of them died (0.3% of AP, 50% of WE). Two patients with WE were treated with parenteral thiamine and survived. Global confusions were seen in all patients with encephalopathy. Ocular abnormalities were found. Conjugate gaze palsies were seen in 1 of 6 (16.7%) patients with PE. Of 4 patients with WE, one (25%) had conjugate gaze palsies, two (50%) had horizontal nystagmus, three (75%) had diplopia, and one (25%) had myosis. Ataxia was not seen in all patients. None of patients with WE presented with the classic clinical triad. CSF examinations for 2 patients with WE showed lightly-increased proteins and glucose. CT and MRI of the brain had no evidence of characteristic abnormalities.


CONCLUSIONS
PE occurs in early or reiteration stage of SAP, and WE in restoration stage of SAP/AP. Ocular abnormalities are the hallmarks of WE, and horizontal nystagmus is common. It is difficult to diagnose earlier an encephalopathy as PE or WE, as well as differentiate one from the other. Long fasting, hyperemesis and total parenteral nutrition (TPN) without thiamine are main causes of thiamine deficiency in the course of pancreatitis.
Sun
Guo-Hui
GH
Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China. sungh301xhk@yahoo.com.cn
Yang
Yun-Sheng
YS
Liu
Qing-Sen
QS
Cheng
Liu-Fang
LF
Huang
Xu-Sheng
XS
D000208:Acute Disease; D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D001928:Brain Diseases, Metabolic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies; D013831:Thiamine / Q000627:therapeutic use; D014899:Wernicke Encephalopathy / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D013831:Thiamine