Nonalcoholic Thiamine-Related Encephalopathy (Wernicke-Korsakoff Syndrome) Among Inpatients With Cancer: A Series of 18 Cases.
Nonalcoholic Thiamine-Related Encephalopathy (Wernicke-Korsakoff Syndrome) Among Inpatients With Cancer: A Series of 18 Cases.
复制标题
DOI：
10.1016/j.psym.2015.10.001
复制
发表时间：
2016-01
期刊：
影响因子：
3.4
通讯作者：
Breitbart W
中科院分区：
文献类型：
--
作者：
Isenberg-Grzeda E;Alici Y;Hatzoglou V;Nelson C;Breitbart W
韦尼克-科尔萨科夫综合征（WKS）是一种由硫胺素缺乏引起的神经精神综合征。癌症通过多种机制导致硫胺素缺乏。尽管存在许多关于非酒精性 WKS 治疗癌症的病例报告，但仍缺乏更大规模的定性研究。对入住癌症医院并在精神病咨询服务的常规护理期间诊断为 WKS 的患者进行回顾性研究。仅纳入至少具有 1 个额外支持特征（磁共振成像结果、低血清硫胺素浓度或对治疗有反应）的患者。通过图表审查从医疗记录中提取有关人口统计、风险因素、现象学和结果的数据。总共包括 18 名患者。所有患者在癌症治疗期间均出现 WKS。血液系统恶性肿瘤、胃肠道肿瘤、低摄入量和体重减轻是常见的危险因素。所有患者均出现认知功能障碍，最常见的是警觉性、注意力和短期记忆受损。所有这些均根据 Caine 等人 1997 年提出的操作标准进行诊断（其中需要满足以下 2 项：营养缺乏、眼部症状、小脑症状以及精神状态改变或轻度记忆障碍）。很少有人展示韦尼克的经典三合会。诊断和治疗延误很常见。只有3名患者完全康复。非酒精性 WKS 可能发生在癌症治疗期间，临床表现为谵妄。诊断应使用操作标准，而不是韦尼克三联征。大多数患者体重不轻，维生素 B12 和叶酸血清浓度正常。多种机制可能导致癌症中硫胺素缺乏和 WKS。鉴于残余发病率较高，研究应侧重于减少诊断和治疗延误。
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. 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. 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. 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.