title: Nonalcoholic Thiamine-Related Encephalopathy (Wernicke-Korsakoff Syndrome) Among Inpatients With Cancer: A Series of 18 Cases.
abstract: BACKGROUND
  Wernicke-Korsakoff Syndrome (WKS) is a neuropsychiatric syndrome caused by thiamine deficiency. Cancer predisposes to thiamine deficiency through various mechanisms. Although many case reports exist on nonalcoholic WKS in cancer, larger qualitative studies are lacking.
  
  
  METHODS
  Retrospective study of patients admitted to a cancer hospital and diagnosed with WKS during routine care on a psychiatric consultation service. Only patients with at least 1 additional supporting feature (magnetic resonance imaging findings, low serum thiamine concentrations, or response to treatment) were included. Data pertaining to demographics, risk factors, phenomenology, and outcomes were abstracted from medical records by chart review.
  
  
  RESULTS
  In all, 18 patients were included. All patients developed WKS during cancer treatment. Hematologic malignancy, gastrointestinal tract tumors, low oral intake, and weight loss were common risk factors. All patients presented with cognitive dysfunction, most commonly impaired alertness, attention, and short-term memory. All were diagnosed by operational criteria proposed by Caine et al., 1997 (where 2 of the following are required: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment). Few exhibited Wernicke's classic triad. Diagnostic and treatment delay were common. Only 3 patients recovered fully.
  
  
  CONCLUSIONS
  Nonalcoholic WKS can occur during cancer treatment and manifests clinically as delirium. Diagnosis should be made using operational criteria, not Wernicke's triad. Most patients were not underweight and had normal serum concentration of vitamin B12 and folate. A variety of mechanisms might predispose to thiamine deficiency and WKS in cancer. Given the high frequency of residual morbidity, studies should focus on decreasing diagnostic and treatment delay.
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Center, Ontario, Canada. Electronic address: eisenberggrzeda@sunnybrook.ca.
authors.forename: Elie
authors.initials: E
authors.lastname: Isenberg-Grzeda
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Memorial Sloan Kettering Cancer Center, Manhattan, NY.
authors.forename: Yesne
authors.initials: Y
authors.lastname: Alici
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, Manhattan, NY.
authors.forename: Vaios
authors.initials: V
authors.lastname: Hatzoglou
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Memorial Sloan Kettering Cancer Center, Manhattan, NY.
authors.forename: Christian
authors.initials: C
authors.lastname: Nelson
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Manhattan, NY.
authors.forename: William
authors.initials: W
authors.lastname: Breitbart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D060825:Cognitive Dysfunction; D003244:Consciousness Disorders; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000453:epidemiology; D006801:Humans; D020915:Korsakoff Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013831:Thiamine / Q000097:blood / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use; D015431:Weight Loss
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine