title: [Wernicke's encephalopathy and Caine criteria. Report of six cases].
abstract: BACKGROUND
  Wernicke's encephalopathy is an acute and reversible neurologic disorder due to deficiency of thiamin. Chronic alcoholism was the main cause in the past; currently, there are many other situations which favour this condition: prolonged intravenous feeding, hyperemesis gravidarum, anorexia nervosa, regional enteritis, malabsorption syndrome, hemodialysis, peritoneal dialysis, and abdominal surgery.
  
  
  METHODS
  We report six patients, three male and three female, who had in common total parenteral nutrition over two months, secondary to abdominal surgery complications and restriction to enteral nutrition. Clinical manifestations were drowsiness, psychomotor hyperactivity, ophthalmoplegia with bilateral abduction impairment, horizontal nystagmus; three patients with ataxia and appendicular dysmetria. Magnetic resonance imaging showed abnormal T2 hyperintensity of the superior colliculus, periaqueductal gray matter, mammillary bodies and dorsomedial nucleus of the thalamus, as well as abnormal T1 hyperintensity in both lenticular nucleus from manganese deposits due to total parenteral nutrition.
  
  
  CONCLUSIONS
  The classical triad is global confusional state, ocular abnormalities and ataxia. However, using the Caine criteria, the diagnosis could be faster in susceptible patients without previous alcoholism.
authors.affiliation: Servicio de Neurología, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal, México. apika38@hotmail.com.
authors.forename: Anke Paula Ingrid
authors.initials: AP
authors.lastname: Kleinert-Altamirano
authors.forename: Humberto
authors.initials: H
authors.lastname: Juárez-Jiménez
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D014899:Wernicke Encephalopathy / Q000175:diagnosis* / Q000209:etiology
keywords: Thiamine deficiency; Total parenteral nutrition; Wernicke encephalopathy