title: Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: a case report and review of the literature.
abstract: OBJECTIVE
  Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients.
  
  
  METHODS
  In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected.
  In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.
authors.affiliation: Department of Psychiatry, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan. h-onishi@jg7.so-net.ne.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Onishi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sugimasa
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kawanishi
authors.forename: Masanari
authors.initials: M
authors.lastname: Onose
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012307:Risk Factors; D013831:Thiamine / Q000008:administration & dosage / Q000097:blood; D013832:Thiamine Deficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014899:Wernicke Encephalopathy / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D013831:Thiamine