title: Challenges in Diagnosis and Treatment of Wernicke Encephalopathy: Report of 2 Cases.
abstract: BACKGROUND
  Wernicke encephalopathy (WE) is a medical emergency caused by thiamine deficiency, characterized by cerebellar ataxia, ophthalmoplegia, and cognitive disturbances that may progress to Korsakoff amnesia. We describe 2 patients with WE who needed high-dose and long-term treatment with thiamine to obtain neurological improvement and recovery.
  
  
  METHODS
  The first patient was a woman diagnosed with non-Hodgkin lymphoma. After a gastrointestinal infection, she developed depression, memory loss, disorientation, behavioral changes, and ataxic paraplegia. Brain magnetic resonance imaging (MRI) showed bilateral alterations in thalamic, frontal, and periaqueductal regions, suggestive of WE. The second patient was a man who lost 10 kg after surgical gastrectomy; he developed diplopia, ophthalmoplegia, cerebellar ataxia, lower limb paresthesias, and amnesia. A brain MRI demonstrated contrast enhancement of mammillary bodies, compatible with WE.
  
  
  RESULTS
  The patients were treated with intramuscular (IM) thiamine (1200 mg/d for 2 months and 900 mg/d for a month, respectively) with gradual cognitive and behavioral improvement and brain MRI normalization, while ataxia and oculomotion improved in following months. In both patients, thiamine was gradually reduced to IM 200 mg/d and continued for a year, without clinical relapses.
  
  
  CONCLUSIONS
  There is no consensus about dosage, frequency, route, and duration of thiamine administration in WE treatment. Based on our cases, we recommend treating patients with WE with higher doses of IM thiamine for a longer time than suggested (900-1200 mg/d for 1-2 months, in our cases) and to gradually reduce dosage after clinical and radiological improvement, maintaining IM 200 mg/d dosage for at least 1 year.
authors: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal-Infantile Sciences, University of Genoa, Largo P. Daneo, Genoa, Italy.
authors: Maria Teresa
authors: MT
authors: Infante
authors: Unit of Neurology, IRCCS San Martino University Hospital IST, Largo R. Benzi, Genoa, Italy roberto.fancellu@hsanmartino.it.
authors: Roberto
authors: R
authors: Fancellu
authors: Unit of Neurology, IRCCS San Martino University Hospital IST, Largo R. Benzi, Genoa, Italy.
authors: Alessandra
authors: A
authors: Murialdo
authors: Unit of Neuroradiology, IRCCS San Martino University Hospital IST, Largo R. Benzi, Genoa, Italy.
authors: Laura
authors: L
authors: Barletta
authors: Unit of Neuroradiology, IRCCS San Martino University Hospital IST, Largo R. Benzi, Genoa, Italy.
authors: Lucio
authors: L
authors: Castellan
authors: Unit of Neurology, IRCCS San Martino University Hospital IST, Largo R. Benzi, Genoa, Italy.
authors: Carlo
authors: C
authors: Serrati
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000150:complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013831:Thiamine / Q000008:administration & dosage / Q000097:blood; D013832:Thiamine Deficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D014899:Wernicke Encephalopathy / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*
chemical_list: D013831:Thiamine
keywords: Wernicke encephalopathy; Wernicke-Korsakoff syndrome; hypovitaminosis B1; malnutrition; thiamine; thiamine deficiency