Wernicke encephalopathy after gastrointestinal surgery for cancer: causes of diagnostic failure or delay.
Wernicke encephalopathy (WE) is a neurological emergency due to thiamine deficiency. We aimed to identify clinical course and causes of diagnostic delay or failure of WE in a group of patients who underwent surgery for gastrointestinal tumors. A retrospective review of clinical, laboratory, neuroimaging, and therapeutic features of 10 patients with WE following abdominal surgery for cancer was carried out. Four patients died; in these subjects, diagnosis was delayed and supplementation of vitamin was absent or likely inadequate. Diagnostic delay or failure was also related to the coexistence of several medical complications at presentation masking typical symptoms of WE. In the surviving patients, outcome was influenced by promptness and type of therapy. Postoperative abdominal bleeding and number of subsequent operations may also had an effect. Postsurgical patients with gastrointestinal tumors may develop a subtle WE. The number of subsequent operations and the severity of postoperative complications may increase the risk of unrecognized WE. The disease should be suspected in postsurgical patients who have unexpected mental status changes, even under prophylactic treatment with vitamins. We suggest that prophylaxis with high doses of thiamine should be undertaken in patients with gastrointestinal tumors before surgery.
Dipartimento di Scienze Neurologiche Neurochirurgiche e del Comportamento, Università degli Studi di Siena, Siena, Italy. rufa@unisi.it
A
A
Rufa
F
F
Rosini
A
A
Cerase
F
F
Giannini
E
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Pretegiani
R
R
Buccoliero
M T
MT
Dotti
A
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Federico
D000368:Aged; D003951:Diagnostic Errors / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013832:Thiamine Deficiency / Q000175:diagnosis* / Q000209:etiology*; D014899:Wernicke Encephalopathy / Q000175:diagnosis* / Q000209:etiology*