Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-29T15:29:34.807Z Has data issue: false hasContentIssue false
  • English
  • Français

Wernicke encephalopathy in a lung cancer patient receiving home medical care

Published online by Cambridge University Press:  23 July 2021

Hiroshi Ito ,
Mayumi Ishida Open the ORCID record for Mayumi Ishida [Opens in a new window] ,
Kumi Itami ,
Akira Yoshioka ,
Izumi Sato ,
Nozomu Uchida Open the ORCID record for Nozomu Uchida [Opens in a new window] ,
Nobuyuki Onizawa  and
Hideki Onishi Open the ORCID record for Hideki Onishi [Opens in a new window]
Hiroshi Ito
Affiliation:
Ito Internal Medicine and Pediatric Clinic, Fukuoka, Japan
Mayumi Ishida*
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Kumi Itami
Affiliation:
Department of Nursing, Saitama Medical University International Medical Center, Saitama, Japan
Akira Yoshioka
Affiliation:
Department of Clinical Oncology, Mitsubishi Kyoto Hospital, Kyoto, Japan
Izumi Sato
Affiliation:
Department of Clinical Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Nobuyuki Onizawa
Affiliation:
Department of General Medicine, Anz clinic, Saitama, Japan
Hideki Onishi
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
*
Author for correspondence: Mayumi Ishida, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan. E-mail: mayumi_i@saitama-med.ac.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Cancer patients often want to spend their final days at home, and it is essential that general practitioners have knowledge of and technical skills related to cancer medicine and symptom relief. Recent clinical studies have revealed that Wernicke encephalopathy (WE) is quite common in cancer patients. However, there have been no reports to date on WE in cancer patients undergoing home medical care.

Methods

From a series of cancer patient undergoing home medical care, we reported a patient with lung cancer who developed WE.

Results

An 84-year-old female with lung cancer undergoing home medical care developed an impaired mental state and an attention deficit. Her symptoms fulfilled the diagnostic criteria for delirium. WE was suspected as the patient's food intake had fallen from normal a month previously to somewhere between 50% or just a few mouthfuls. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after thiamine administration.

Significance of the results

When delirium occurs in cancer patients undergoing home treatment, it is necessary to suspect thiamine deficiency as a potential cause, as appropriate diagnosis and treatment can prevent irreversible brain-related sequelae.

Keywords

CancerDeliriumHome careThiamine deficiencyWernicke encephalopathy
Type
Case Report
Information
Palliative & Supportive Care , Volume 19 , Issue 4 , August 2021 , pp. 501 - 503
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Publishing.Google Scholar
Barbato, M and Rodriguez, PJ (1994) Thiamine deficiency in patients admitted to a palliative care unit. Palliative Medicine 8(4), 320–324.CrossRefGoogle ScholarPubMed
Galvin, R, Brathen, G, Ivashynka, A, et al. (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European Journal of Neurology 17(12), 1408–1418.CrossRefGoogle ScholarPubMed
Inouye, SK (1994) The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. American Journal of Medicine 97(3), 278–288.CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, Kutner, HE and Nicolson, SE (2012) Wernicke-Korsakoff-syndrome: Under-recognized and under-treated. Psychosomatics 53(6), 507–516.CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, Shen, MJ, Alici, Y, et al. (2017) High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: Results of a single site prevalence study. Psychooncology 26(9), 1384–1389.CrossRefGoogle ScholarPubMed
Kaira, K, Takahashi, T, Murakami, H, et al. (2010) Long-term survivors of more than 5 years in advanced non-small cell lung cancer. Lung Cancer 67(1), 120–123.CrossRefGoogle ScholarPubMed
MacLean, LD, Rhode, BM and Shizgal, HM (1983) Nutrition following gastric operations for morbid obesity. Annals of Surgery 198(3), 347–355.CrossRefGoogle ScholarPubMed
Mitchell, GK, Senior, HE, Johnson, CE, et al. (2018) Systematic review of general practice end-of-life symptom control. BMJ Support Palliative Care 8(4), 411–420.CrossRefGoogle ScholarPubMed
Nakamura, S, Kuzuya, M, Funaki, Y, et al. (2010) Factors influencing death at home in terminally ill cancer patients. Geriatrics & Gerontology International 10(2), 154–160.Google ScholarPubMed
Onishi, H, Ishida, M, Toyama, H, et al. (2018a) Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. Palliative Support Care 14(3), 302–306.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018b) Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic. Palliative Support Care 16(5), 633–636.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018c) Subclinical thiamine deficiency in patients with abdominal cancer. Palliative Support Care 16(4), 497–499.CrossRefGoogle Scholar
Onishi, H, Sato, I, Uchida, N, et al. (2021) High proportion of thiamine deficiency in referred cancer patients with delirium: A retrospective descriptive study. European Journal of Clinical Nutrition. Online ahead of print. doi:10.1038/s41430-021-00859-9.CrossRefGoogle ScholarPubMed
Posner, BE, Smigelski, CG and Krachenfels, MM (1987) Dietary characteristics and nutrient intake in an urban homebound population. Journal of the American Dietetic Association 87(4), 452–456.Google Scholar
Rainsford, S, MacLeod, RD and Glasgow, NJ (2016) Place of death in rural palliative care: A systematic review. Palliative Medicine 30(8), 745–763.CrossRefGoogle ScholarPubMed
Sandberg, O, Gustafson, Y, Brännström, B, et al. (1998) Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scandinavian Journal of Social Medicine 26(1), 56–62.CrossRefGoogle ScholarPubMed
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurology 6(5), 442–455.CrossRefGoogle ScholarPubMed
Sechi, G, Sechi, E, Fois, C, et al. (2016) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutrition Reviews 74(5), 281–300.CrossRefGoogle ScholarPubMed
Wilkinson, TJ, Hanger, HC, Elmslie, J, et al. (1997) The response to treatment of subclinical thiamine deficiency in the elderly. American Journal of Clinical Nutrition 66(4), 925–928.CrossRefGoogle ScholarPubMed
Yoshioka, A, Sato, I, Onishi, H, et al. (2021) Subclinical thiamine deficiency identified by pretreatment evaluation in an esophageal cancer patient. European Journal of Clinical Nutrition 75(3), 564–566.CrossRefGoogle Scholar