1/17. Nonalcoholic Wernicke's encephalopathy with prominent astasia and optic neuropathy.OBJECTIVE: To present a case with nonalcoholic Wernicke's encephalopathy (WE) developing astasia and optic neuropathy as major sequelae. CLINICAL PRESENTATION AND INTERVENTION: A 47-year-old woman developed WE following operation for pyloric stenosis. She received total parenteral nutrition before and after operation, but on the second postoperative day she developed visual hallucination and confusion, followed by nystagmus, ophthalmoplegia, apathy, dysarthria and coma. Although the patient has recovered with thiamine treatment, astasia and optic neuropathy persisted s major morbidities. CONCLUSION: The report shows that astasia and optic neuropathy may be prominent sequelae in some patients with WE.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/17. Computed tomography findings in thiamine deficiency-induced coma.Although brain magnetic resonance imaging is a more sensitive diagnostic tool in the evaluation of coma, noncontrast head computed tomography (CT) may demonstrate highly specific findings in some cases of coma. We present a case of thiamine deficiency-induced coma associated with acute necrosis of fornices documented on CT and review cardinal neuroimaging features of wernicke encephalopathy. Acute fornices necrosis is a novel finding on head CT suggestive of thiamine deficiency.- - - - - - - - - - ranking = 7keywords = coma (Clic here for more details about this article) |
3/17. Wernicke's encephalopathy.Wernicke's encephalopathy should be considered as a possible diagnosis in comatose and hypothermic patients. The classic triad of confusion, ophthalmoplegia (or nystagmus) and ataxia may be absent, and the history of alcohol abuse or other causes of thiamine deficiency may be unknown. Left untreated, acute Wernicke's encephalopathy has a 17 percent mortality rate. Since the morbidity from Wernicke's encephalopathy is potentially reversible with parenteral thiamine, and large doses of thiamine can be given without documented ill effects, it is recommended that all comatose or hypothermic patients, as well as those with more classic presentations of Wernicke's encephalopathy, be given parenteral thiamine before administration of glucose.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
4/17. Wernicke-like encephalopathy after autologous bone marrow transplantation.A 15-year-old boy with non-T ALL in early 2nd remission was autografted using a regimen with busulphan 4 mg/kg/day, po, from day -9 to -6, and cyclophosphamide 50 mg/kg/day, iv, from day -5 to -2. During busulphan administration he experienced a few generalized seizures, and starting on day 25 post ABMT he developed a progressively severe neurological symptomatology characterized by nystagmus, right VIth cranial nerve palsy, truncal ataxia and, finally, confusion and coma. MRI showed lesions in the periaqueductal gray matter, thalamus, mammillary bodies and putamen. Within 24 hours of treatment with thiamine he improved dramatically, but during the following weeks permanent neurologic damage with memory deficit, truncal ataxia and nystagmus became evident. To our knowledge this is the first case of Wernicke's encephalopathy reported after BMT. We suspect in this case a contribution of busulphan to the development of the syndrome.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/17. Papilloedema delaying diagnosis of Wernicke's encephalopathy in a comatose patient.A case of acute Wernicke's encephalopathy due to hyperemesis gravidarum is described. Florid bilateral papilloedema was present, resulting in diagnostic uncertainty and delay in treatment. attention is drawn to the rare occurrence of papilloedema in Wernicke's encephalopathy, and possible underlying mechanisms for this physical finding are considered.- - - - - - - - - - ranking = 4keywords = coma (Clic here for more details about this article) |
6/17. Isolated ophthalmoplegia of abduction.A case of transient complete bilateral paresis of abduction is reported without esotropia. Loss of vestibular ocular reflex (VOR) responses of the abducting eye and intactness of all other slow VOR reactions were the leading symptoms. Since bilateral lesions of the pontine gaze centers in this initially comatose patient without signs of increased intracranial pressure were excluded, bilateral lesions of the abducens nerves appeared improbable. In view of normal function of the ascending tract of Deiters bilateral paramedian lesions between the vestibular and abducens nuclei appeared to be more likely. Clinical course with relatively rapid recovery after administration of thiamine, theoretical considerations, and some earlier reports led to the conclusion that in some metabolic-toxic disorders--apparently in this case of Wernicke's encephalopathy--intrapontine connections in the paraabducens area may be selectively vulnerable. A similar effect on oligosynaptic connections to the medial rectus nucleus could lead to a disordered inhibition of this muscle. The term "posterior INO of Lutz" should no longer be used because of the lack of any anatomical and physiological evidence for its existence.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/17. coma as presenting manifestation of Wernicke's encephalopathy.A patient in whom coma was the presenting manifestation of Wernicke's encephalopathy is reported. Clinical reports on coma in Wernicke's encephalopathy are scarce, but postmortem studies have demonstrated that this form of presentation is often not recognized. The diagnosis of Wernicke's encephalopathy should be suspected in any patient presenting with coma of unclear etiology.- - - - - - - - - - ranking = 3keywords = coma (Clic here for more details about this article) |
8/17. Reversible coma in Wernicke's encephalopathy.A case of coma due to Wernicke's encephalopathy complicated by respiratory failure is described. ventilation and thiamine administration lead to recovery, although Korsakoff's psychosis and ataxia persisted. A review of similar cases of coma emphasizes the absence of diagnostic features, but that if structural disease is excluded the presence of pupillary and ocular signs may support a diagnosis of Wernicke's encephalopathy. The response to thiamine may be diagnostic as in 8 of these patients who received it, but the long-term morbidity remains high.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
9/17. Wernicke's encephalopathy in early pregnancy complicated by disseminated intravascular coagulation.A 29 year-old Japanese woman with hyperemesis gravidarum became comatose and died. The autopsy revealed a typical case of Wernicke's encephalopathy complicated by disseminated intravascular coagulation (DIC). Repeated vomiting and parenteral nutrition without vitamins led to Wernicke's encephalopathy and a spontaneous abortion 24 h before death triggered the induction of DIC.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/17. Computed tomographic findings in Wernicke-korsakoff syndrome.An unconscious patient had a differential diagnosis of coma. Traumatic, metabolic, and infectious origins were considered, but none explained her condition satisfactorily. Clinical features on examination were compatible with Wernicke-korsakoff syndrome. Her condition improved with supportive treatment and thiamine hydrochloride administration. A computed tomographic scan showed large, symmetric, low-density thalamic lesions, the condition of which improved after three months.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
| | Next -> |