Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: a case report and review of the literature.
Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: a case report and review of the literature.
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DOI：
10.1017/s1478951505050510
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发表时间：
2005-12-01
影响因子：
2.2
通讯作者：
Onose, Masanari
中科院分区：
文献类型：
--
作者：
Onishi, Hideki;Sugimasa, Yukio;Onose, Masanari
目的：尽管在肿瘤学文献中已有韦尼克脑病的报道，但在癌症术后患者中尚未见报道。方法：在这篇文章中，我们报道了一位肝细胞癌合并肝硬化的患者，他以术后谵妄的形式发展为韦尼克脑病。术前，患者食欲良好，至术前1天饮食均为1800卡/天。手术没有发生任何并发症。患者在肝切除2天后出现谵妄。谵妄水平保持不变，直到术后第7天开始给予硫胺素，导致谵妄缓解，无脑损伤。实验室数据显示，术后第6天血清硫胺素水平低于正常下限。作为Wernicke脑病的机制，我们认为肝硬化导致的硫胺素储存能力下降导致硫胺素的消耗比预期的要快。研究结果和意义：在癌症患者中，临床医生必须始终保持对韦尼克脑病的可能性的认识，特别是在肝功能障碍患者中，这降低了肝脏储存硫胺素的能力。早期发现和干预可以减轻谵妄的症状，防止不可逆的脑损伤。
OBJECTIVE: Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients.METHODS: In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected.RESULTS AND SIGNIFICANCE OF THE RESEARCH: In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.