title: Wernicke's encephalopathy in a patient with gastric carcinoma: a diagnosis not to miss.
abstract: We describe a case of a patient who presented with a 20-day history of vomiting, generalised weakness and loss of appetite and a 2-day history of altered sensorium. On examination, he was grossly emaciated and there were no palpable lymph nodes. Central nervous system examination revealed nystagmus with bilateral lateral recti palsy and abdominal examination showed mild hepatomegaly. MRI of the brain showed bilateral and symmetrical hypertense signal changes in T2-weighted and fluid-attenuated inversion recovery sequences with diffusion restriction in the paramedian ventromedial thalamus. These findings were compatible with Wernicke's encephalopathy. He was started on thiamine supplementation with which neurological signs improved. An ultrasound of the abdomen showed mild hepatomegaly with multiple hyperechoic lesions and wall thickening of the pyloric antrum. Upper gastroduodenoscopy showed ulcerative lesions involving the antrum, pylorus and duodenum. Biopsy revealed moderately differentiated adenocarcinoma. The patient underwent palliative gastrojejunostomy and was clinically better at discharge. It is important to consider Wernicke encephalopathy in patients with gastric cancer who have acute neurological symptoms.
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Chandrashekar Udyavara
authors.initials: CU
authors.lastname: Kudru
authors.forename: Shivashankara Kaniyoor
authors.initials: SK
authors.lastname: Nagiri
authors.forename: Sandeep
authors.initials: S
authors.lastname: Rao
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D001921:Brain / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis*; D013831:Thiamine / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D014803:Vitamin B Complex / Q000627:therapeutic use; D014839:Vomiting / Q000150:complications*; D014899:Wernicke Encephalopathy / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine