Wernicke-Korsakoff syndrome in patients with cancer: a systematic review.
Wernicke-Korsakoff syndrome in patients with cancer is understudied. Much of what is known-that significant under-recognition and delays in treatment exist-comes from studies of alcohol misuse disorders or non-alcohol-related Wernicke-Korsakoff syndrome in patients. We investigated the frequency and associated features of cancer-related Wernicke-Korsakoff syndrome in the published literature. We included 90 articles reporting on 129 patients. Only 38 (30%) of 128 patients with data available exhibited the entire triad of classic features of Wernicke-Korsakoff syndrome: confusion, ataxia, and ophthalmoplegia or nystagmus. Diagnosis during life was missed altogether in 22 (17%) of 128 patients. The operational diagnostic criteria (at least two of the following: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment), which are considered more reliable than the classical triad, were used in only nine (7%) cases, yet 120 (94%) met the operational criteria for diagnosis at the time of presentation when applied retroactively. Complete recovery was reported in only 47 (36%) cases. Given that oncologists or haematologists accounted for only 17 (19%) first authors among the articles included, it is important that oncologists are aware of the risk factors for cancer-related Wernicke-Korsakoff syndrome, and that they are vigilant about diagnosing and treating the disease especially in the absence of alcohol misuse disorders.
Department of Psychiatry, Sunnybrook Health Sciences Center, Toronto, ON, Canada. Electronic address: eisenberggrzeda@sunnybrook.ca.
Elie
E
Isenberg-Grzeda
Department of Psychiatry, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
Sudhanshu
S
Rahane
Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Antonio P
AP
DeRosa
Department of Psychiatry, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
Janet
J
Ellis
Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA.
Stephen E
SE
Nicolson
D001259:Ataxia / Q000209:etiology / Q000503:physiopathology; D003221:Confusion / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D020915:Korsakoff Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology; D009886:Ophthalmoplegia / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors