title: Wernicke's encephalopathy in advanced gastric cancer.
abstract: OBJECTIVE
  With their prolonged survival and malnutrition, cancer patients, and especially gastrointestinal (GI) tract cancer patients, can develop Wernicke's encephalopathy (WE). The aim of this study is to remind physicians of the importance of WE and prompt management in patients with GI tract cancer.
  
  
  METHODS
  This study is a retrospective review of 2 cases of WE in advanced gastric cancer (AGC) patients, and we review the literature for cases of GI tract cancer related to WE.
  
  
  RESULTS
  A 48-year-old female with AGC presented dizziness and diplopia for 5 days and a 20 kg weight loss. Neurologic exam showed nystagmus and gaze disturbance. Her symptoms improved after daily parenteral injection of thiamine 100 mg for 17 days. A 58-year-old female with AGC presented with sudden disorientation, confusion and 15 kg weight loss. Neurologic exam showed gaze limitation and mild ataxia. Despite daily parenteral injection of thiamine 100 mg for 4 days, she died 5 days after the onset of neurologic symptoms. Combining the cases noted in the literature review with our 2 cases, the 7 gastric cancer cases and 2 colorectal cancer cases related to WE showed similar clinical characteristics; 1) a history of long-period malnutrition and weight loss, 2) relatively typical neurologic signs and symptoms and 3) specific magnetic resonance image findings. Except for 2 patients who had irreversible neurologic symptoms, the other 7 patients were improved with prompt thiamine treatment.
  
  
  CONCLUSIONS
  It is important to consider WE in GI tract cancer patients with acute neurologic symptoms and who are in a state of malnutrition. Thiamine should be given as soon as possible when WE is suspected.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Jung
authors.forename: Obin
authors.initials: O
authors.lastname: Kwon
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Lee
authors.forename: Joo Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Yoon
authors.forename: Gun Min
authors.initials: GM
authors.lastname: Kim
authors.forename: Hei-Cheul
authors.initials: HC
authors.lastname: Jeung
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha