Wernicke encephalopathy in a non-alcoholic patient with diabetic nephropathy under hemodialysis

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  • Nakatani-Enomoto Setsu
    Department of Neurology, School of Medicine, Fukushima Medical University
  • Moriya Arata
    Department of Neurology, School of Medicine, Fukushima Medical University
  • Kikuchi Saeko
    Department of Neurology, School of Medicine, Fukushima Medical University
  • Mochizuki Hitoshi
    Department of Neurology, School of Medicine, Fukushima Medical University
  • Sugiura Yoshihiro
    Department of Neurology, School of Medicine, Fukushima Medical University
  • Ugawa Yoshikazu
    Department of Neurology, School of Medicine, Fukushima Medical University

Bibliographic Information

Other Title
  • 糖尿病性腎症に対する血液透析療法中に非アルコール性ウェルニッケ脳症を呈した１例
  • トウニョウビョウセイジンショウ ニ タイスル ケツエキ トウセキ リョウホウ チュウ ニ ヒアルコールセイ ウェルニッケ ノウショウ オ テイシタ 1レイ

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Abstract

A 75-year-old man with diabetic nephropathy treated with hemodialysis visited to a medical office because of slight fever, and received intravenous glucose infusion without any vitamins. Thereafter, he noticed gait disturbance and began to tell inconsistent stories. He was admitted to our hospital due to aggravation of these symptoms. On admission, he was disoriented and not able to sit by himself because of severe truncal ataxia without weakness. He had also gaze direction nystagmus. Based on clinical features, we considered him as having Wernicke's encephalopathy (WE) and treated him with 100mg thiamine per day. The thiamine supply diminished these symptoms soon. Plasma thiamine level prior to the administration was 7ng/ml, which confirmed the diagnosis. MRI did not disclose any abnormalities frequently seen in WE.<br> WE is a life-threatening disease, and 'early detection, early cure' is important for recovering without sequelae. The thiamine deficiency is often seen in dialysis patients because of dietary restrictions as well as its loss during dialysis. This case gives us the caution; when hemodialysis patients present acute/subacute gait disturbance and/or abnormal mental state, we should consider WE. Furthermore, high-risk patients, such as elderly patients under hemodialysis may need some supplement including thiamine even at preclinical stage.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 50 (6), 409-411, 2010

    Societas Neurologica Japonica

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