A case of Wernicke-Korsakoff syndrome with dramatic improvement in consciousness immediately after intravenous infusion of thiamine

Akio Kikuchi, Keiji Chida, Tatsurou Misu, Naoshi Okita, Hiroshi Nomura, Hidehiko Konno, Sadao Takase, Atsushi Takeda, Yasuto Itoyama

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

A 68-year-old man was hospitalized on March 4, 1998 for disturbances in consciousness. In 1995, he had received proximal subtotal gastrectomy and reconstructive surgery of the jejunal interposition for gastric cancer. Thereafter he had been taking enough food without the habit of taking liquor. In October 1997, his short term memory was becoming gradually worse. On February 12, 1998, he suffered from numbness in the feet, and then dysphagia, unsteady gait, and diplopia developed gradually. On February 26, brain MRI showed no abnormalities. On March 3, he had a fever of 38.5°C and his consciousness became unclear. Neurological examination revealed semicoma, total ophthalmoplegia, and absence of doll's eye movement. Deep tendon reflexes were absent. The serum thiamine level was 9 ng/ml (normal range: 20- 50). Brain MRI demonstrated symmetrical high intensity lesions in the periaqueductal area of the midbrain, dorsomedial nuclei of bilateral thalami, and vestibular nuclei. About 30 seconds after intravenous infusion of thiamine, his consciousness improved dramatically, but returned to semicoma after about two minutes. Wernicke-Korsakoff syndrome usually occurs acutely. In the present case, however, the disease showed slow onset, chronic progression, and then rapid worsening after fever. Reconstructive surgery of the jejunal interposition might have caused the slow onset of Wernicke- Korsakoff syndrome, and fever might have facilitated the rapid progression of the disease. An immediate high concentration of thiamine modifies the kinetics of acetylcholine receptor ion channels, thereby maintaining wakefulness, and the level of consciousness may change dramatically.

Original languageEnglish
Pages (from-to)59-63
Number of pages5
JournalBrain and Nerve
Volume52
Issue number1
Publication statusPublished - 2000 Feb 23

Keywords

  • Acetylcholine
  • Fever
  • Reconstructive surgery of jejunal interposition
  • Thiamine
  • Wernicke-Korsakoff syndrome

ASJC Scopus subject areas

  • Neuroscience(all)

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