Wernicke Encephalopathy, Miller Fisher Syndrome; Differential Diagnostic Details In The Context of Case Presentation
Abstract
Wernicke Encephalopathy WE is a treatable neurological disorder known since 1881 and has a high mortality and morbidity rate if left untreated. Although the classical triad of symptoms are confusion, ataxia and ophtalmoparesis, different findings such as decreased deep tendon reflexes, areflexia or weakness has been reported. Another neurological disorder, Miller Fisher Syndrome MFS has a similar triad of ataxia, ophtalmoparesis and areflexia and reports of patients who have been mistakenly diagnosed with one of the two conditions are noteworthy in the medical literature. In this report we describe a patient who was initially considered as MFS and later was diagnosed with WE. We discuss the striking similarities and differential diagnosis of WE and MFS
Keywords
Wernicke Encephalopathy Miller Fisher Syndrome Erythrocyte transcetolase activity ophthalmoparesis thiamine
References
- Galvin R, Bråthen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA; EFNS. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 2010; 17:1408-18.
- Francini-Pesenti F, Brocadello F, Manara R, Santelli L, Laroni A, Caregaro L. Wernicke’s syndrome during parenteral feeding: not an unusual complication. Nutrition 2009; 25:142-146
- Thomson AD. Mechanisms of vitamin deficiency in chronic alcohol misusers and the development of the Wernicke-Korsakoff syndrome. Alcohol Alcohol Suppl 2000; 35:2-7.
- Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006; 61:255–268
- Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosisand management. Lancet Neurol 2007; 6:442-55.
- So YT and Simon RP(2004) Deficiency diseases of the nervous system. In Neurology in Clinical Practice, edn 2, 1701-1704. Philadelphia:Elsevier Inc.
- C G Harper, M Giles, and R Finlay-Jones. Clinical signs in the Wernicke- Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry 1986; 49: 341–345.
- de la Cruz-Cosme C, Padilla-Parrado F, García-Casares N, Heras- Pérez JA,Sempere-Fernández J, Serrano-Castro V, Romero-Acebal M. Miller Fisher syndrome as the presenting symptom of Wernicke’s encephalopathy. Rev Neurol 2008; 46:472-475.
- Becker U, Gahn G, Reichmann H, Herting B. Miller Fisher syndrome: case report and review with discussion of differential diagnosis and nosolog. Nervenarzt 2006; 77:716-21.
- Truedsson M, Ohlsson B, Sjöberg K. Wernicke’s encephalopathy presenting with severe dysphagia: a case report. Alcohol Alcohol 2002; 37:295-6.
- Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s Encephalopathy and Korsakoff’s Psychosis. Alcohol Alcohol 2006;41:151-8.
- Guerrini I, Thomson AD, Cook CC, McQuillin A, Sharma V, Kopelman M, Reynolds G, Jauhar P, Harper C, Gurling HM. Direct genomic PCR sequencing of the high affinity thiamine transporter (SLC19A2) gene identifies three genetic variants in Wernicke Korsakoff syndrome (WKS). Am J Med Genet B Neuropsychiatr Genet 2005;137B:17-9.
- Coy JF, Dübel S, Kioschis P, Thomas K, Micklem G, Delius H, Poustka A. Molecular cloning of tissue-specific transcripts of a transketolase- related gene: implications for the evolution of new vertebrate genes. Genomics 1996; 15;32:309-16.
- Gibson GE, Ksiezak-Reding H, Sheu KFR, Mykytyn V, Blass JP. Correlation of enzymatic, metabolic and behavioral deficits in thiamine deficiency and its reversal. Neurochem Res 1984; 9:803-814.
- Butterworth RF. Pathophysiologic mechanisms responsible for the reversible (thiamine-responsive) and irreversible (thiamine non- responsive) neurological symptoms of Wernicke’s encephalopathy. Drug Alcohol Rev 1993;12:315-22.
- Sullivan EV, Pfefferbaum A. Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol 2009; 44:155-65.
Abstract
Wernicke ensefalopatisi WE , 1881 yılından beri bilinen mortalitesi ve morbiditesi yüksek, tedavisi mümkün nörolojik bir hastalıktır. Hastalığın klinik triadı konfüzyon, ataksi, oftalmoparezi olmakla birlikte derin tendon reflekslerinde azalma, arefleksi ve kas güçsüzlüğü de ek klinik bulgular olarak bildirilmiştir. Miller Fisher sendromunun klasik triadı ise ataksi, oftalmoparezi, arefleksidir ve benzer klinik bulguları içeren bu iki klinik tanının karıştırıldığına dair literatür dikkat çekicidir. Bu yazıda, başlangıçta Miller Fisher Sendromu düşünülüp daha sonra Wernicke Ensefalopatisi teşhisi konan olgu eşliğinde klinik yanılsama durumu tartışılmıştır
Keywords
Wernicke Ensefalopatisi Miller-Fisher Sendromu Eritrosit transketolaz aktivitesi oftalmoparezi tiamin
References
- Galvin R, Bråthen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA; EFNS. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 2010; 17:1408-18.
- Francini-Pesenti F, Brocadello F, Manara R, Santelli L, Laroni A, Caregaro L. Wernicke’s syndrome during parenteral feeding: not an unusual complication. Nutrition 2009; 25:142-146
- Thomson AD. Mechanisms of vitamin deficiency in chronic alcohol misusers and the development of the Wernicke-Korsakoff syndrome. Alcohol Alcohol Suppl 2000; 35:2-7.
- Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006; 61:255–268
- Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosisand management. Lancet Neurol 2007; 6:442-55.
- So YT and Simon RP(2004) Deficiency diseases of the nervous system. In Neurology in Clinical Practice, edn 2, 1701-1704. Philadelphia:Elsevier Inc.
- C G Harper, M Giles, and R Finlay-Jones. Clinical signs in the Wernicke- Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry 1986; 49: 341–345.
- de la Cruz-Cosme C, Padilla-Parrado F, García-Casares N, Heras- Pérez JA,Sempere-Fernández J, Serrano-Castro V, Romero-Acebal M. Miller Fisher syndrome as the presenting symptom of Wernicke’s encephalopathy. Rev Neurol 2008; 46:472-475.
- Becker U, Gahn G, Reichmann H, Herting B. Miller Fisher syndrome: case report and review with discussion of differential diagnosis and nosolog. Nervenarzt 2006; 77:716-21.
- Truedsson M, Ohlsson B, Sjöberg K. Wernicke’s encephalopathy presenting with severe dysphagia: a case report. Alcohol Alcohol 2002; 37:295-6.
- Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s Encephalopathy and Korsakoff’s Psychosis. Alcohol Alcohol 2006;41:151-8.
- Guerrini I, Thomson AD, Cook CC, McQuillin A, Sharma V, Kopelman M, Reynolds G, Jauhar P, Harper C, Gurling HM. Direct genomic PCR sequencing of the high affinity thiamine transporter (SLC19A2) gene identifies three genetic variants in Wernicke Korsakoff syndrome (WKS). Am J Med Genet B Neuropsychiatr Genet 2005;137B:17-9.
- Coy JF, Dübel S, Kioschis P, Thomas K, Micklem G, Delius H, Poustka A. Molecular cloning of tissue-specific transcripts of a transketolase- related gene: implications for the evolution of new vertebrate genes. Genomics 1996; 15;32:309-16.
- Gibson GE, Ksiezak-Reding H, Sheu KFR, Mykytyn V, Blass JP. Correlation of enzymatic, metabolic and behavioral deficits in thiamine deficiency and its reversal. Neurochem Res 1984; 9:803-814.
- Butterworth RF. Pathophysiologic mechanisms responsible for the reversible (thiamine-responsive) and irreversible (thiamine non- responsive) neurological symptoms of Wernicke’s encephalopathy. Drug Alcohol Rev 1993;12:315-22.
- Sullivan EV, Pfefferbaum A. Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol 2009; 44:155-65.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | December 1, 2013 |
| Published in Issue | Year 2013Issue: 4 |