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Clin Neurol Neurosurg 2020 Jun 20;196:106034. Epub 2020 Jun 20.

Department of Radiology, St. Vincent Hospital, Worcester, MA, United States.

Obes Surg 2020 Jun 27. Epub 2020 Jun 27.

Center for Obesity Surgery (CCO), University of Buenos Aires (UBA), Buenos Aires, Argentina.

Wernicke encephalopathy (WE) is a rare and serious complication of obesity surgery. This is a report of one case of WE after a sleeve gastrectomy. The diagnosis is primarily clinical; the persistent and prolonged vomiting, and noncompliance to vitamin intake are two major risk factors to develop WE. Read More

Neurocase 2020 Jun 26:1-4. Epub 2020 Jun 26.

Department of Psychiatry, Erenköy Mental Health and Neurology, Training&Research Hospital , İstanbul, Turkey.

Wernicke encephalopathy (WE) is a neuropsychiatric condition associated with  thiamine deficiency that includes a triad of mental status changes, ophthalmoplegia, and ataxia. Worsening WE may lead to Korsakoff syndrome(KS), in which cognitive impairments such as confabulation and memory deficits and also psychiatric symptoms may occur. Diagnosis of Wernicke-Korsakoff syndrome can be complicated in many cases. Read More

Front Neurol 2020 10;11:451. Epub 2020 Jun 10.

Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

The classical triad-ophthalmoplegia, cerebellar dysfunction, and altered mental state-in addition to bilateral symmetrical periventricular lesions are actually common to see, and clinicians tend to associate that with Wernicke's encephalopathy (WE). The diagnosis is strengthened with a likely deficiency of thiamine. We herein describe a malnourished patient with clinical triad and hyperintensities in the circumventricular regions, and she turned out to have neuromyelitis optica spectrum disorder (NMOSD) after many twists and turns. Read More

Cureus 2020 May 22;12(5):e8242. Epub 2020 May 22.

Internal Medicine, University of Arizona, Tucson, USA.

Most commonly seen with alcohol use disorder in the developed world, Wernicke's encephalopathy (WE), a disorder caused by thiamine deficiency can be readily missed in the setting of other predisposing conditions such as malnutrition, the most common cause worldwide. We present a case of a 21-year-old female with sudden progressive decline in her level of alertness and mentation along with severe hypothermia who had clinical features and imaging findings consistent with WE in the setting of pancreatitis and chronic gastritis. WE should be suspected in all patients who present with altered mental status (AMS) and who are at an increased risk of malnutrition despite a normal or high body mass index, so that treatment with thiamine may be initiated and further neurologic sequelae can be averted. Read More

J Neuroimmunol 2020 Aug 5;345:577285. Epub 2020 Jun 5.

University of Toronto, Division of Neurology, Canada; University Health Network, Toronto, Canada. Electronic address:

Objective: To determine the prevalence of cerebrospinal fluid (CSF) markers associated with inflammation (i.e., elevated white blood cell count, protein concentration, and CSF-specific oligoclonal bands) in patients with early active autoimmune encephalitis (AE). Read More

Noro Psikiyatr Ars 2020 Jun 16;57(2):165-168. Epub 2019 Aug 16.

Istanbul Training and Research Hospital, Radiology Department, Istanbul, Turkey.

Wernicke encephalopathy is a neurological disorder, clasically characterized by altered consciousness, ophtalmoparesis, and ataxia results from tiamin deficiency. It is frequently associated with chronic alcohol abuse; however, many conditions which lead to thiamine deficiency such as gastric surgery, hyperemesis, parenteral nutrition, malnutrition may also be the cause. WE is a life-threatening condition that requires early diagnosis and rapid initiation of intravenous thiamin therapy. Read More

J Audiol Otol 2020 Jun 12. Epub 2020 Jun 12.

Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA.

Sensorineural hearing loss (SNHL) is seldom associated with Wernicke encephalopathy (WE) or thiamine deficiency. While thiamine deficiency and repletion are often considered prior to dextrose infusions in patients with chronic alcohol abuse to prevent WE, they are often overlooked in non-alcoholic patients who are also at risk for malnutrition. In this paper we describe a case of a non-alcoholic 28-year-old female status post-sleeve gastrectomy who developed SNHL in the setting of thiamine deficiency and WE, with ongoing hearing impairment requiring hearing aids despite thiamine repletion. Read More

A A Pract 2020 Jun;14(8):e01230

From the Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.

Gayet-Wernicke encephalopathy (WE) is an acute neurological disorder resulting from deficiency of thiamine, commonly related to chronic abuse of alcohol, but frequently missed or overlooked as a diagnosis when a nonalcoholic patient presents with atypical signs and symptoms of the disease. The diagnosis of the disease is clinical, and confirmation is done by magnetic resonance imaging. We aim to highlight a case of WE in a nonalcoholic postoperative surgical patient receiving total parental nutrition where high-dose intravenous administration of thiamine in time mitigated the symptoms of disease and prevented permanent neurological sequelae. Read More

Turk J Pediatr 2020 ;62(2):310-314

Departments of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.

Background: Wernicke`s encephalopathy (WE) is a coenzyme-induced disease with acute neuropsychiatric symptoms leading to high mortality and morbidity due to thiamine deficiency. WE is mostly caused by alcoholism in adult populations; however, it is often associated with gastrointestinal surgical procedures, recurrent vomiting, chronic diarrhea, cancer and chemotherapy treatment, systemic diseases, drugs, magnesium deficiency, and malnutrition in children. Although these predisposing factors are considered to be uncommon in children, they are actually highly frequent and can be fatal if not treated promptly. Read More

CMAJ Open 2020 Apr-Jun;8(2):E383-E390. Epub 2020 May 15.

Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont.

Background: Oral thiamine therapy is frequently prescribed to patients at risk for thiamine deficiency despite recommendations emphasizing the need for high doses of parenteral thiamine to reverse brain thiamine deficits. We evaluated the effect of changes to the computerized provider order entry system on the proportion of prescriptions for parenteral thiamine treatment (primary outcome) and dosages prescribed (secondary outcome) within our academic hospital network.

Methods: We obtained data from the pharmacy information system recording thiamine prescribed to inpatients at University Health Network hospitals (Toronto, Ontario) before (Jan. Read More

CMAJ 2020 Apr;192(15):E409

Clinical director, Advanced Health Analytics (AHA Health Ltd.), Calgary, Alta.

Prim Care Companion CNS Disord 2020 May 7;22(3). Epub 2020 May 7.

Department of Psychiatry, Prof. Dr. Fernando da Fonseca Hospital, Amadora, Portugal.

Wernicke-Korsakoff syndrome (WKS) is a life-threatening and underdiagnosed neuropsychiatric condition caused by thiamine deficiency that comprises Wernicke encephalopathy and Korsakoff syndrome. Although mainly associated with chronic alcoholism, WKS can arise from other circumstances. This report describes a series of cases of WKS that were clinically evaluated by liaison psychiatrists on a nonpsychiatric inpatient unit. Read More

Jpn J Radiol 2020 May 10. Epub 2020 May 10.

The Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA.

Wernicke's encephalopathy (WE) is a severe and life-threatening illness resulting from vitamin B1 (thiamine) deficiency. The prevalence of WE has been estimated from 0.4 to 2. Read More

Blood Adv 2020 Apr;4(8):1792-1800

Mays Cancer Center, UT Health San Antonio MD Anderson, San Antonio, TX.

Following the discovery of the JAK2V617F mutation in myeloproliferative neoplasms in 2005, fedratinib was developed as a small molecular inhibitor of JAK2. It was optimized to yield low-nanomolar activity against JAK2 (50% inhibitory concentration = 3 nM) and was identified to be selective for JAK2 relative to other JAK family members (eg, JAK1, JAK3, and TYK2). It quickly moved into clinical development with a phase 1 clinical trial opening in 2008, where a favorable impact on spleen and myelofibrosis (MF) symptom responses was reported. Read More

Rev Esp Enferm Dig 2020 May;112(5):422

Aparato Digestivo, Hospital Universitario San Agustín, España.

Wernicke´s encephalopathy (WE) is an acute neurologic disorder secondary to thiamine deficiency. We report the case of a patient with history of bariatric surgery who develops a late-onset enterocolic fistula, with alcohol consumption associated. Read More

Cureus 2020 Mar 23;12(3):e7378. Epub 2020 Mar 23.

Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, USA.

Sleeve gastrectomy is a restrictive-type weight loss surgery that can result in nutritional deficiencies, such as vitamin B1 (thiamine) deficiency. Although Wernicke's encephalopathy is a known complication following bariatric surgery, bilateral sensorineural hearing loss is a rare presenting symptom of this condition. We present a case of a patient two months postoperative following a sleeve gastrectomy whose chief complaint was hearing loss. Read More

Medicine (Baltimore) 2020 Apr;99(16):e19799

Department of Nutrition, the First Hospital of Shanxi Medical University.

Introduction: Wernicke's encephalopathy (WE) is a severe neuropsychiatric disorder, which results from a nutritional deficiency of thiamine. The occurrence of WE is rarely reported in patients with cerebral infarction, who often have complications of malnutrition. Cerebral infarction is a neurological disease, patients with cerebral infarction may show symptoms such as disturbance of consciousness and gait instability, which is difficult to differentiate from WE. Read More

Indian Pediatr 2020 Apr;57(4):369-370

Section of Pediatric Critical Care Medicine, Department of Pediatrics, Dokuz Eylül University School of Medicine, Izmir, Turkey.

Thiamine deficiency can cause encephalopathy (Wernicke) and lactic acidosis. Herein we report a 6-year-old girl on total parenteral nutrition (TPN) who developed lactic acidosis and neurological symptoms due to improper vitamin replacement, which responded to thiamine injection. The MRI brain findings were not typical for Wernicke encephalopathy. Read More

J Radiol Case Rep 2019 Sep 30;13(9):1-7. Epub 2019 Sep 30.

Department of Radiology, Changi General Hospital, Singapore.

Metronidazole induced encephalopathy is a rare central nervous system toxicity, which may be completely reversible with prompt cessation of metronidazole usage. We present a case of metronidazole induced encephalopathy in a 59-year-old man with a history of Whipple's procedure for pancreatic neuroendocrine tumour. The characteristic magnetic resonance imaging features of metronidazole induced encephalopathy and its main differential diagnosis, Wernicke's encephalopathy, are discussed. Read More

Eat Weight Disord 2020 Mar 4. Epub 2020 Mar 4.

Neurology Unit, "A. Manzoni" Hospital-ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy.

Introduction: Nowadays, reports of beriberi are rare in developed countries. Wernicke encephalopathy may be present in about 25% of patients with beriberi.

Case Report: We report the case of a woman with history of depression and chronic eating disorder, who complained Wernicke encephalopathy and beriberi. Read More

Eur J Clin Nutr 2020 Apr 2;74(4):663-665. Epub 2020 Mar 2.

Department of Internal Medicine, St. Michael's Hospital, Bratislava, Slovakia.

We report a rare case of Wernicke encephalopathy (WE) in a 35-year-old woman with hyperemesis gravidarum (HG). Initially, the disease manifested as passivity, a loss of interest, sleeping too much, apathy and disorientation. The correct diagnosis was established after the detection of typical pathological findings of WE in the thalamus by magnetic resonance imaging (MRI), which was indicated for the appearance of eye symptomatology in the form of nystagmus. Read More

Addiction 2020 Feb 28. Epub 2020 Feb 28.

University of Oxford, Big Data Institute, Nuffield Department of Population Health.

A diagnosis of alcohol use disorder is associated with a higher risk of dementia, but a dose-response relationship between alcohol intake consumption and cognitive impairment remains unclear. Alcohol is associated with a range of effects on the central nervous system at different doses and acts on a number of receptors. Acute disorders include Wernicke's encephalopathy (WE), traumatic brain injury, blackouts, seizures, stroke and hepatic encephalopathy. Read More

CMAJ 2020 02;192(6):E143

Departments of General Internal Medicine (Fujikawa) and Ophthalmology (Sogabe), Mitoyo General Hospital, Kanonji, Kagawa, Japan.

Zhonghua Nei Ke Za Zhi 2020 Jan;59(1):82-85

Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.

A 43-year-old male presented with elevated serum creatinine for 4 years and developed abdominal pain for 3 days. He started peritoneal dialysis 2 months ago. Dialysis-related peritonitis was ruled out and acute gastroenteritis was diagnosed. Read More

Clin Nutr 2019 Dec 11. Epub 2019 Dec 11.

Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznań, Poland.

Background & Aims: Wernicke's encephalopathy is associated mainly with malnourishment in alcohol-dependent patients but can be caused also by cancer, Crohn's disease, gastrointestinal surgery or prolonged parenteral nutrition (PN) without adequate supplementation of vitamins. The disorder, with a significant mortality rate of up to 20%, is often associated with the underlying disease and intensifies after administration of non-supplemented PN. Thus, it seems justified to add thiamine to PN admixtures prepared for parenterally fed patients. Read More

Am J Emerg Med 2020 03 16;38(3):690.e3-690.e5. Epub 2019 Nov 16.

Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.

Emergency physicians frequently treat hyperemesis gravidarum and should be aware of possible complications. Wernicke encephalopathy secondary to thiamine deficiency should be considered in the differential diagnosis of acute encephalopathy in pregnant women. A seventeen-week pregnant 27-year-old woman presented to the Emergency Department with nausea, emesis, and right upper quadrant abdominal pain. Read More

BMJ Case Rep 2019 Nov 14;12(11). Epub 2019 Nov 14.

Radiology, Weston Area Health NHS Trust, Weston-super-Mare, UK.

A 61-year-old obese man presented with 8-week history of nausea and occasional vomiting. He reported poor appetite and unintentional weight loss of more than 20 kg of his body mass. A week after admission, he developed double vision and unsteady gait. Read More

Can J Ophthalmol 2020 Apr 13;55(2):e69-e70. Epub 2019 Sep 13.

University of Texas Medical Branch, Galveston, TX; Weill Cornell Medicine, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Texas A and M College of Medicine, Bryan, TX; The University of Iowa Hospitals and Clinics, Iowa City, IA. Electronic address:

Turk J Emerg Med 2019 Oct 22;19(4):154-156. Epub 2019 Aug 22.

Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.

Introduction: Non-alcoholic Wernicke encephalopathy (WE) is a life-threatening condition, which is caused due to thiamine deficiency. We reported a case of non-alcoholic WE following gastrojejunostomy.

Case Presentation: A 31-year-old woman was admitted to our tertiary care center complaining about intractable nausea and vomiting following her gastrojejunostomy. Read More

J Neurol Sci 2020 01 1;408:116551. Epub 2019 Nov 1.

Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Yazakokarimata 1-1, Nagakute, Aichi, Japan.

Endocr Pract 2019 Dec 4;25(12):1346-1359. Epub 2019 Nov 4.

The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. Read More

Proc (Bayl Univ Med Cent) 2019 Oct 18;32(4):607-609. Epub 2019 Sep 18.

Division of Neuropsychology, Baylor Scott & White HealthTempleTexas.

Wernicke encephalopathy (WE), caused by thiamine deficiency, is classically associated with alcoholism but is increasingly recognized among patients who have undergone bariatric surgery. As with other neurocognitive conditions, alternative explanations for symptoms, such as psychiatric, neurological, and motivational factors, must be considered before arriving at a diagnosis of WE. We present a patient after sleeve gastrectomy who was presumed to have WE; after detailed neuropsychological assessment, the condition was better conceptualized as a conversion disorder. Read More

Front Neurol 2019 27;10:1035. Epub 2019 Sep 27.

Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.

To reveal the neural basis of Wernicke's encephalopathy (WE) with impaired vestibulo-ocular reflex (VOR), we evaluated resting-state functional connectivity (rs-fc) in the vestibular processing brain regions. Rs-fc between the vestibular regions and the rest of the brain were compared with neurotological features including the head-impulse tests (vHIT) and caloric responses in patients with WE ( = 5, mean age 53.4 ± 10 years) and healthy controls ( = 20, mean age 55. Read More

Psychosomatics 2020 Jan - Feb;61(1):31-38. Epub 2019 Aug 14.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.

Background: Wernicke-Korsakoff Syndrome (WKS) resulting from thiamine deficiency is classically defined as including encephalopathy, ataxia, and ophthalmoplegia. Only 16% of autopsy-confirmed patients with WKS exhibit all three signs. Caine-positive WKS criteria include two or more of the following: nutritional deficiency, delirium or mild memory impairment, cerebellar dysfunction/ataxia, and oculomotor abnormalities. Read More

Therapie 2020 May - Jun;75(3):281-294. Epub 2019 Sep 9.

Service d'addictologie, hôpitaux de Brabois, centre hospitalier régional universitaire, 54511 Vandœuvre-lès-Nancy, France.

Objective: The survey aimed to estimate, in the presence of alcohol use disorder, the frequency of systematic prescription of thiamine, the factors associated with it, and those related to the administration (oral, intravenous, intramuscular) when Wernicke's encephalopathy is suspected.

Methods: A self-questionnaire available on Internet was sent by e-mail to doctors and nurses taking care patients with alcohol use disorder.

Results: In all, 565 professionals responded. Read More

Alcohol Alcohol 2019 Dec;54(6):609-614

King's College London, Institute of Psychiatry, Psychology and Neuroscience London SE5 8AF, UK.

Aim: To offer an estimate of the incidence of anaphylactic reactions to parenteral products containing thiamine used in the treatment of Wernicke's encephalopathy (WE) and make recommendations.

Method: Review of previously released data on some older products and parenteral thiamine use in some other countries; analysis of sales and adverse incident data on anaphylaxis for a contemporary parenteral product used in the UK, Pabrinex.

Results: It was difficult to estimate the incidence of related anaphylactic reactions to Pabrinex in the UK because the number of doses given is unknown. Read More

Cureus 2019 Jul 22;11(7):e5203. Epub 2019 Jul 22.

Radiology, Aventura Hospital and Medical Center, Aventura, USA.

Wernicke encephalopathy is a neurological complication of thiamine deficiency, usually in the setting of poor diet, classically with alcoholism. Patients present with acute onset of encephalopathy, oculomotor dysfunction, gait ataxia and memory impairment. If untreated, the disorder can result in severe morbidity and possibly death; patient outcomes are entirely dependent on prompt diagnosis and administration of parenteral thiamine. Read More

Iran J Neurol 2019 Apr;18(2):85-86

Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Pediatr Gastroenterol Hepatol Nutr 2019 Sep 11;22(5):493-499. Epub 2019 Sep 11.

3rd Department of Pediatrics, Hippokration General Hospital, Thessaloniki, Greece.

Thiamine (vitamin B) is a water-soluble vitamin that is not endogenously synthesized in humans. It is absorbed by the small intestine, where it is activated. Its active form acts as a coenzyme in many energy pathways. Read More

Case Rep Neurol 2019 Jan-Apr;11(1):124-131. Epub 2019 Apr 18.

Renown Institute for Neuroscience, Renown Health, Reno, Nevada, USA.

An otherwise healthy 30-year-old male acquired gastrointestinal beriberi and subsequent Wernicke's encephalopathy after 1 session of heavy drinking. Nausea, vomiting, and anorexia relentlessly progressed. The patient developed external ophthalmoplegia after 2 months. Read More

Cureus 2019 Jul 17;11(7):e5156. Epub 2019 Jul 17.

Gastroenterology, Aventura Hospital, Aventura, USA.

Wernicke's Encephalopathy (WE) is a neurological condition characterized by ophthalmoplegia, ataxic gait, and altered mental status. It is an underdiagnosed yet severely limiting disease process precipitated by thiamine deficiency. Often times, it can occur in conjunction with other disease states like refeeding syndrome in which the underlying etiology is prolonged periods of malnutrition. Read More

Palliat Support Care 2020 04;18(2):241-243

Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan.

Background: Nivolumab has become an effective treatment option for cancer in various sites; however, this drug may cause immune-related adverse effects due to its mechanism of action. Furthermore, little has been reported on thiamine deficiency (TD) in patients receiving nivolumab treatment.

Method: From a series of cancer patients, we reported a patient with recurrent renal cell carcinoma who developed TD after the start of nivolumab treatment. Read More

Semin Neurol 2019 08 18;39(4):428-439. Epub 2019 Sep 18.

Department of Neurology, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania.

Prion diseases are a phenotypically diverse set of disorders characterized by protease-resistant abnormally shaped proteins known as prions. There are three main groups of prion diseases, termed sporadic (Creutzfeldt-Jakob disease [CJD], sporadic fatal insomnia, and variably protease-sensitive prionopathy), genetic (genetic CJD, fatal familial insomnia, and Gerstmann-Straussler-Scheinker syndrome), and acquired (kuru, variant CJD, and iatrogenic CJD). This article will review the pathophysiology, genetics, clinical presentations, and diagnostic challenges in patients with prion disease. Read More

Nat Rev Dis Primers 2019 09 12;5(1):62. Epub 2019 Sep 12.

Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Nausea and vomiting of pregnancy (NVP) is a common condition that affects as many as 70% of pregnant women. Although no consensus definition is available for hyperemesis gravidarum (HG), it is typically viewed as the severe form of NVP and has been reported to occur in 0.3-10. Read More

Neurol India 2019 Jul-Aug;67(4):1112-1115

Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

To report a patient with Wernicke's encephalopathy (WE) using multimodal magnetic resonance imaging (MRI) including conventional MRI, diffusion-weighted MRI (DWI), arterial spin labeling (ASL), and proton MR spectroscopy (MRS). A 50-year-old woman of WE with a history of cholecystectomy and acute pancreatitis was given MRI scans including DWI, MRS, and ASL pre- and post-thiamine treatment. Two weeks after admission, the patient's condition rapidly improved. Read More

J Int Med Res 2019 Oct 10;47(10):4886-4894. Epub 2019 Sep 10.

Department of Critical Care Medicine, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China.