WERNICKE’S NON-ALCOHOLIC ENCEPHALOPATHY: A CLINICAL OBSERVATION

Pinchuk V. A., Silenko G. Ya., Delwa M. Yu., Kryvchun A. M., Delwa І. І.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. The article presents an example of our own clinical observation of a case of Wernicke’s encephalopathy (WE) of non-alcoholic origin – a disease caused by thiamine deficiency, which was first described by ophthalmologist A. Gayet (1875) and neurologist K. Wernicke in 1881. Clinical and diagnostic criteria of this pathology are discussed. The prevalence of WE is 0.8–2.8%. In addition to the alcoholic origin of this disease, numerous cases of Wernicke’s encephalopathy have been described that are not related to alcohol consumption. At the same time there is a violation of the conversion of thiamine to thiamine pyrophosphate, which leads to the development of local lactic acidosis, mitochondrial dysfunction, inhibition of tissue respiration, reduced energy potential of neurons and glia cells. Diagnosis of WE is clinical, based on history and examination of patients. Only in 20% of cases of WE confirmed at autopsy, the diagnosis was made in life. Caine criteria include: malnutrition; oculomotor disorders; cerebellar dysfunction; mental and/or mnestic disorders. Also used erythrocyte transketolase test and thiamine pyrophosphate effect. The specificity of magnetic resonance imaging in this disease, namely in T1 and FLAIR mode, diagnoses a symmetrical increase in signal intensity from the areas around the 3rd ventricle and aqueduct, thalamus, hypothalamus and mammary bodies. These foci are sometimes very pronounced in the acute phase and disappear during treatment, especially at the stage of reverse biochemical changes. In the chronic stage of WE, tomography shows only atrophy of the brain with diffuse changes in signal intensity in the white matter. In the treatment of WE use vitamin B1, a balanced diet. Numerous studies suggest the need for timely treatment, the delay of which can lead to irreversible neuronal death and even death. Knowledge of this pathology will help doctors not only to correctly diagnose, but also to prescribe timely pathogenetic treatment.

non-alcoholic Wernicke’s encephalopathy, Cain’s criteria, thiamine deficiency.

1. Ota Y, Capizzano AA, Moritani T, Naganawa S, Kurokawa R, Srinivasan A. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol. 2020;38(9):809-20.
2. Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL. Wernicke Encephalopathy-Clinical Pearls. Mayo Clin Proc. 2019;94(6):1065-72.
3. Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke – Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J. Neurol. Neurosurg. Psychiatry. 1986;49:341-5.
4. Emelyanova EA, Asekritova AS, Semenova TI, Nikolaeva KM. Entsefalopatiya Vernike: nablyudeniya iz praktiki. Sovremennyie problemyi nauki i obrazovaniya. 2019;6:34-6. [in Russian].
5. Sivolap YuP, Damulin IV. Entsefalopatiya Vernike i korsakovskiy psihoz: kliniko-patogeneticheskie sootnosheniya, diagnostika i lechenie. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. Spetsvyipuski. 2013;113(6.2):20-6. [in Russian].
6. Yin H, Xu Q, Cao Y, Qi Y, Yu T, Lu W. Nonalcoholic Wernicke’s encephalopathy: a retrospective study of 17 cases. J Int Med Res. 2019;47(10):4886-94.
7. Brew BJ. Diagnosis of Wernicke’s encephalopathy. Aust N Z J Med. 1986;16(5):676-8.
8. Sivolap IuP, Damulin IV. Sindrom Vernike-Korsakova. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2014;4:76–80. [in Russian].
9. Grigor’eva VN, Guzanova EV, Mukhin VV. Entsefalopatiia Vernike, tsentral’nyi pontinnyi mielinoliz, i polinevropatiia u bol’nykh s neukrotimoi rvotoi beremennykh (hyperemesis gravidarum). Nevrol. Zhurn. 2016;3:131-41. [in Russian].
10. Serdyuk AV, Kovrazhkina EA, Abramova EA. Sluchay entsefalopatii Vernike nealkogolnogo geneza. Consilium Medicum. 2019;21(9):24-5. [in Russian].
11. Day GS, del Campo CM. Wernicke encephalopathy: a medical emergency. CMAJ. 2014;186(8):295.
12. Lough ME. Wernicke’s encephalopathy: expanding the diagnostic toolbox. Neuropsychol Rev. 2012;22(2):181-94.
13. Kleinert-Altamirano AP, Juárez-Jiménez H. Encefalopatía de Wernicke y criterios de Caine. Informe de seis casos. Rev Med Inst Mex Seguro Soc. 2014;52(1):104-7.
14. Davies SB, Joshua FF, Zagami AS. Wernicke’s encephalopathy in a nonalcoholic patient with a normal blood thiamine level. Med J Aust 2011;194(9):483-4.
15. Abbas SA, Abboud H, Chalah MA, Sabbagh C, Ayache SS. Isolated Mammillary Bodies Damage-An Atypical Presentation of Wernicke Syndrome. Behav Sci (Basel). 2018 Nov 12;8(11):104.
16. Santos Andrade C, Tavares Lucato L, da Graça Morais Martin M, Joaquina Marques-Dias M, Antonio Pezzi Portela L, Scarabôtolo Gattás G, et al. Non-alcoholic Wernicke’s encephalopathy: broadening the clinicoradiological spectrum. Br J Radiol. 2010;83(989):437-46.
17. Sivolap YuP, DamulIn IV. Sindrom VernIke-Korsakova. NevrologIya, neyropsihIatrIya, psihosomatika. 2014;4:76-80. [in Russian].
18. MatvIEnko Yu. EntsefalopatIya VernIke. Meditsina svItu [Internet]. 2011;31:3. Dostupno: http://msvitu.com/archive/2011/october/article-3. php? print=1. [in Ukrainian].
19. Thomson AD, Marshall EJ. The treatment of patients at risk of developing Wernicke’s encephalopathy in the community. Alcohol Alcohol. 2006;41(2):159-67.
20. PInchuk VA, Krivchun AM, Silenko GYa. MIstse olatropIlu v lIkuvannya kognItivnih rozladIv u patsIEntIv Iz rozsIyanim sklerozom. UkraYinskiy vIsnik psihonevrologIYi. 2018;2(95):22-5. [in Ukrainian].
21. Litvinenko NV, PInchuk VA, Silenko GYa. EfektivnIst neyromIdinu v kompleksnIy terapIYi kognItivnih rozladIv u patsIEntIv Iz retsidivuyuchoremItuyuchim rozsIyanim sklerozom.UkraYinskiy vIsnik psihonevrologIYi. 2013;21(77):130-2. [in Ukrainian].
22. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442-55.
23. Kopelman MD, Thomson AD, Guerrini I, Marshall EJ. The Korsakoff syndrome: clinical aspects, psychology and treatment. Alcohol Alcohol. 2009;44(2):148-54.

«Bulletin of problems biology and medicine» Issue 2 (160), 2021 year, 123-126 pages, index UDK 616.831.55-002.151-03

10.29254/2077-4214-2021-2-160-123-126