Encefalopatia de Wernicke: A propósito de um caso com síndrome pilórica obstrutiva

Oliveira, Hélio Araújo; Leopoldino, José Fábio Santos

doi:10.1590/S0004-282X1995000300021

Resumos

Os autores apresentam um caso de encefalopatia de Wernicke em um paciente com síndrome de obstrução pilórica por adenocarcinoma gástrico, sem história de alcoolismo e desnutrição. Comentam aspectos fisiológicos da importância da tiamina como co-enzima da transcetolase e da piruvato-descarboxilase na rota metabólica para produção de ATP e a possibilidade da existência de interação de fatores genéticos e ambientais no surgimento do quadro clínico. Chamam a atenção para a importância do diagnóstico clínico, que deve ser precoce para que a terapêutica específica com tiamina possa surtir efeito, principalmente em pacientes sem história prévia de alcoolismo e desnutrição.

encefalopatia de Wernicke; tiamina; obstrução pilórica; adenocarcinoma gástrico

The authors present one case of Wernicke's encephalopathy in a patient with obstructive pyloric syndrome caused by gastric adenocarcinoma, wihout previous history of alcoholism or malnutrition. They comment on the importance of physiological aspects of thiamine as a co-enzyme of transketolase and pyruvate-decarboxilase in the metabolic pathway for ATP production and the possibility of existing an interaction between genetical and environmental factors in the onset the symptoms. They draw attention for the clinical diagnosis, which should be precocious for the therapy with thiamine to be efective, especially in patients without previous history of alcoholism or malnutrition.

Wernicke's encephalopathy; thiamine; pyloric obstruction; gastric adenocarcinoma

Encefalopatia de Wernicke. A propósito de um caso com síndrome pilórica obstrutiva

Wernicke's encephalopathy: report of a case with obstructive pyloric syndrome

Hélio Araújo Oliveira^I; José Fábio Santos Leopoldino^II

^IProfessor Adjunto do Departamento de Medicina - Clínica Neurológica

^IIMédico Estagiário da Clínica Neurológica

RESUMO

Os autores apresentam um caso de encefalopatia de Wernicke em um paciente com síndrome de obstrução pilórica por adenocarcinoma gástrico, sem história de alcoolismo e desnutrição. Comentam aspectos fisiológicos da importância da tiamina como co-enzima da transcetolase e da piruvato-descarboxilase na rota metabólica para produção de ATP e a possibilidade da existência de interação de fatores genéticos e ambientais no surgimento do quadro clínico. Chamam a atenção para a importância do diagnóstico clínico, que deve ser precoce para que a terapêutica específica com tiamina possa surtir efeito, principalmente em pacientes sem história prévia de alcoolismo e desnutrição.

Palavras-chave:encefalopatia de Wernicke, tiamina, obstrução pilórica, adenocarcinoma gástrico.

SUMMARY

The authors present one case of Wernicke's encephalopathy in a patient with obstructive pyloric syndrome caused by gastric adenocarcinoma, wihout previous history of alcoholism or malnutrition. They comment on the importance of physiological aspects of thiamine as a co-enzyme of transketolase and pyruvate-decarboxilase in the metabolic pathway for ATP production and the possibility of existing an interaction between genetical and environmental factors in the onset the symptoms. They draw attention for the clinical diagnosis, which should be precocious for the therapy with thiamine to be efective, especially in patients without previous history of alcoholism or malnutrition.

Key words:Wernicke's encephalopathy, thiamine, pyloric obstruction, gastric adenocarcinoma.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 16-janeiro-1995.

Dr. Hélio Araújo Oliveira - Rua Reginaldo Passos Pina 261, Parque dos Coqueiros - 49040-000 Aracaju SE -Brasil.

1. Brack W, Cristen HJ, Lakomek H, Hanefeld F, Friends RL. Wernicke's encephalopathy in a child with acute lymphoblastic leukemia treated with polychemoterapy. Clin Neuropathol 1991, 10:134-136.
2. Craviotto H, Korein J, Silbur J. Wernicke's encephalopathy: a clinical and pathological study of 28 autopsied cases. Arch Neurol 1961, 4:510-519.
3. Devathasan G, Koh C. Wernicke's encephalopathy in prolonged fasting. Lancet 1982, 13:1108-1109.
4. Descambes E, Dessibourg CR, Felloy G. Acute encephalopathy due to thiamine deficiency (Wernicke's encephalopathy) in a cronic dialyzed patient: a case report. Clin Nephrol 1991, 35:171-175.
5. Ebels EJ. Underlying illness in Wernicke's encephalopathy: analysis of possible causes of under diagnosis. Eur Neurol 1974, 12:226-228.
6. Figueira ICV, Laks J. Encefalopatia de Wernicke. J Bras Psiquiatr 1988, 37:33-38.
7. Fischer AJ, Yellowless PM. Prevention of the Wernicke-Korsakoff syndrome in Australia; a cost-benefit analysis. Med J Aust 1989, 150:331-333.
8. Handler CE, Perkin GD. Anorexia nervosa and Wernicke's encephalopathy: an underdiagnosed association. Lancet 1982, 2:771-772.
9. Harper CG. Sudden unexpected death and Wernicke's encephalopathy: a complication of prolonged intravenous feeding. Aust N Z J Med 1980, 10:230-235.
10. Lana-Peixoto MA, Santos EC, Pittella JE. Coma and death in unrecognized Wernicke's encephalopathy. Arq Neuropsiquiatr 1992, 50:329-333.
11. Lavin PSM, Smith D, Kori SH, Ellenberger C Jr. Wernicke's encephalopathy: a predictable complication of hyperemesis gravidarum. Obst Gynecol 1983, 62:13-15.
12. Lindboe CF, Erichsen AA. Atrophy and sponginess of the mammillary bodies with neuronal sparing: not only inactive Wernicke's encephalopathy. APMIS 1989, 97:667-670.
13. Lindboe CF, Loberg EM. Wernicke's encephalopathy in non-alcoholics: an autopsy study. J Neurol Sci 1989, 90:125-129.
14. Montane V, Imbert Y, Dupont E, Pelegrini JL, Leng B. Encephalopatie de Gayet-Wernicke par vomissements gravidiques. Press Med 1990, 19:83-84.
15. Nakada T, Knight RT. Alcohol and the central nervous system. Med Clin N Am 1984, 63:121-131.
16. Nightingale S, Heath PD, Bates D, Bassan SL. Wernicke's encephalopathy in hyperemesis gravidarum. Postgrad Med J 1982, 58:558-559.
17. Olvera R, Juan E, Moreno MEV, Rosas JS, Ochoa EV. Neuropathologic lesions associated with chronic alcoholism. Rev Invest Clin 1986, 38:375-381.
18. Schenker S, Henderson GI, Hoyumpa AM, McCandless DW. Hepatic and Wernicke's encephalopathies: current conceps of pathogenesis. Am J Clin Nutr 1985, 33:2714-2726.
19. Shogry ME, Curner JT. Mammillary body enhancement on MR as the only sign of acute Wernicke's encephalopathy. Am J Neuroradiol 1994, 15:172-174.
20. Soffer F, Zinkin H, Alkan C, Bergines VM. Wernicke's encephalopathy in acquired imune deficiency syndrome (AIDS): a case report. Clin Neuropathol 1989, 8:192-194.
21. Turner S, Daniels L, Greer S. Wernicke's encephalopathy in a 18-year-old-woman. Br J Psychiatry 1989, 154:261-262.
22. Victor M, Adams R. Doenças carenciais do sistema nervoso. In Harrisson TH. Medicina interna Ed 10. Rio de Janeiro: Guanabara - Koogan 1984, Vol 2, p 2345-2351.
23. Wood P, Murray A, Sinha B, Gadley M, Goldsmith HJ. Wernicke's encephalopathy induced by heperemesis gravidarum: case report. Br J Obstet Gynecol 1983, 90:583-586.
24. Ziporin ZZ, Nunes WT, Powell RC. Thiamine requirement in the adult human mensured by urinary excretion of thiamine metabolites. J Nutr 1965, 85:297-301.

Datas de Publicação

Publicação nesta coleção
09 Dez 2010
Data do Fascículo
Set 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Brack W, Cristen HJ, Lakomek H, Hanefeld F, Friends RL. Wernicke's encephalopathy in a child with acute lymphoblastic leukemia treated with polychemoterapy. Clin Neuropathol 1991, 10:134-136.

[2] 2. Craviotto H, Korein J, Silbur J. Wernicke's encephalopathy: a clinical and pathological study of 28 autopsied cases. Arch Neurol 1961, 4:510-519.

[3] 3. Devathasan G, Koh C. Wernicke's encephalopathy in prolonged fasting. Lancet 1982, 13:1108-1109.

[4] 4. Descambes E, Dessibourg CR, Felloy G. Acute encephalopathy due to thiamine deficiency (Wernicke's encephalopathy) in a cronic dialyzed patient: a case report. Clin Nephrol 1991, 35:171-175.

[5] 5. Ebels EJ. Underlying illness in Wernicke's encephalopathy: analysis of possible causes of under diagnosis. Eur Neurol 1974, 12:226-228.

[6] 6. Figueira ICV, Laks J. Encefalopatia de Wernicke. J Bras Psiquiatr 1988, 37:33-38.

[7] 7. Fischer AJ, Yellowless PM. Prevention of the Wernicke-Korsakoff syndrome in Australia; a cost-benefit analysis. Med J Aust 1989, 150:331-333.

[8] 8. Handler CE, Perkin GD. Anorexia nervosa and Wernicke's encephalopathy: an underdiagnosed association. Lancet 1982, 2:771-772.

[9] 9. Harper CG. Sudden unexpected death and Wernicke's encephalopathy: a complication of prolonged intravenous feeding. Aust N Z J Med 1980, 10:230-235.

[10] 10. Lana-Peixoto MA, Santos EC, Pittella JE. Coma and death in unrecognized Wernicke's encephalopathy. Arq Neuropsiquiatr 1992, 50:329-333.

[11] 11. Lavin PSM, Smith D, Kori SH, Ellenberger C Jr. Wernicke's encephalopathy: a predictable complication of hyperemesis gravidarum. Obst Gynecol 1983, 62:13-15.

[12] 12. Lindboe CF, Erichsen AA. Atrophy and sponginess of the mammillary bodies with neuronal sparing: not only inactive Wernicke's encephalopathy. APMIS 1989, 97:667-670.

[13] 13. Lindboe CF, Loberg EM. Wernicke's encephalopathy in non-alcoholics: an autopsy study. J Neurol Sci 1989, 90:125-129.

[14] 14. Montane V, Imbert Y, Dupont E, Pelegrini JL, Leng B. Encephalopatie de Gayet-Wernicke par vomissements gravidiques. Press Med 1990, 19:83-84.

[15] 15. Nakada T, Knight RT. Alcohol and the central nervous system. Med Clin N Am 1984, 63:121-131.

[16] 16. Nightingale S, Heath PD, Bates D, Bassan SL. Wernicke's encephalopathy in hyperemesis gravidarum. Postgrad Med J 1982, 58:558-559.

[17] 17. Olvera R, Juan E, Moreno MEV, Rosas JS, Ochoa EV. Neuropathologic lesions associated with chronic alcoholism. Rev Invest Clin 1986, 38:375-381.

[18] 18. Schenker S, Henderson GI, Hoyumpa AM, McCandless DW. Hepatic and Wernicke's encephalopathies: current conceps of pathogenesis. Am J Clin Nutr 1985, 33:2714-2726.

[19] 19. Shogry ME, Curner JT. Mammillary body enhancement on MR as the only sign of acute Wernicke's encephalopathy. Am J Neuroradiol 1994, 15:172-174.

[20] 20. Soffer F, Zinkin H, Alkan C, Bergines VM. Wernicke's encephalopathy in acquired imune deficiency syndrome (AIDS): a case report. Clin Neuropathol 1989, 8:192-194.

[21] 21. Turner S, Daniels L, Greer S. Wernicke's encephalopathy in a 18-year-old-woman. Br J Psychiatry 1989, 154:261-262.

[22] 22. Victor M, Adams R. Doenças carenciais do sistema nervoso. In Harrisson TH. Medicina interna Ed 10. Rio de Janeiro: Guanabara - Koogan 1984, Vol 2, p 2345-2351.

[23] 23. Wood P, Murray A, Sinha B, Gadley M, Goldsmith HJ. Wernicke's encephalopathy induced by heperemesis gravidarum: case report. Br J Obstet Gynecol 1983, 90:583-586.

[24] 24. Ziporin ZZ, Nunes WT, Powell RC. Thiamine requirement in the adult human mensured by urinary excretion of thiamine metabolites. J Nutr 1965, 85:297-301.