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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Wernicke's encephalopathy (WE) is most commonly associated with alcoholism, although other causes have also been implicated. In the years 1994-1997, 9 patients with no history of alcohol abuse presented with acute signs of ophthalmoplegia or nystagmus and ataxia which resolved within 48 h after intravenous thiamine. There were 7 women and 2 men aged 17-57 (7 below the age of 30). Precipitating events included vomiting 2, drastic weight-reducing diet 2, renal colic in a postpartum woman 1, colonic surgery 2 and chronic hemodialysis 1. In 2 patients there was no obvious precipitating event but their history was suggestive of a genetic predisposition. Mental changes were slight or absent in all patients and all of them made good functional recovery. These cases suggest that the diagnosis of WE should be considered more often in nonalcoholics in various clinical settings.
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PMID:Thiamine-responsive acute neurological disorders in nonalcoholic patients. 1115 Aug 38

Wernicke's encephalopathy, a serious neurological disorder caused by thiamine deficiency, is most commonly found in chronic alcoholics. We present a typical case of Wernicke's encephalopathy in a non-alcoholic man. Our patient presented with altered mental status, slurred speech, fever, vomiting and headache of one-week duration. An infectious etiology of the symptoms was ruled out by spinal fluid cultures. The patient improved dramatically within 24 hours of administration of thiamine.
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PMID:Wernicke's encephalopathy in a non-alcoholic man: case report and brief review. 1137 96

We present a case of a 25-year-old woman with drowsiness, nystagmus, severe ataxia and areflexia, which developed six weeks after admission to an obstetric clinic for hyperemesis gravidarum. She had been treated with intravenous dextrose and electrolyte solutions and antiemetics. Magnetic resonance imaging (MRI) performed on the fifth day of her neurologic symptoms showed increased intensity in both thalami, periaqueductal grey matter, the floor of the fourth ventricle and superior cerebellar vermis in T2 weighted and FLAIR images. Clinical signs and MRI findings were consistent with the diagnosis of Wernicke's encephalopathy. On the third day of thiamine replacement, neurologic signs improved dramatically In addition to our case, we review 29 previously reported cases of Wernicke's encephalopathy associated with hyperemesis gravidarum, and emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy especially if they are given intravenous or parenteral nutrition.
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PMID:Wernicke's encephalopathy due to hyperemesis gravidarum: an under-recognised condition. 1178 26

Patients suffering from nausea and vomiting of pregnancy (NVP) frequently do not receive therapy, in part because of fears of adverse effects of medications on the fetus. Several vitamin-based and herbal therapies have been shown to be effective and safe. Two randomized trials of vitamin B(6) have shown a benefit in reducing NVP. Women taking periconceptional multivitamins are less likely to have severe NVP. The combination of vitamin B(6) and doxylamine (previously marketed in the United States as Bendectin) has been shown to be safe for the fetus and effective in reducing NVP. Ginger was shown, in 2 studies, to reduce NVP. Vitamin B(1) (thiamine) deficiency can lead to Wernicke's encephalopathy in women with severe NVP. Replacement is needed for all women with vomiting of more than 3 weeks' duration. Prophylaxis with multivitamins and therapy with B(6), with or without doxylamine, are safe and effective therapies for NVP.
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PMID:Overview of nausea and vomiting of pregnancy with an emphasis on vitamins and ginger. 1201 96

A patient with severe vomiting following gastric banding developed Wernicke's encephalopathy. All neurological disorders disappeared with thiamine treatment. This complication may be prevented by keen awareness, early diagnosis and treatment, in patients with persistent vomiting. Vitamin and mineral supplementation must be taken in patients following bariatric surgery.
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PMID:Rapid onset of Wernicke's encephalopathy following gastric restrictive surgery. 1293 73

Complications of bariatric operations include the development of nutritional deficiencies. If protracted vomiting is added, severe vitamin depletion could arise such as thiamine deficiency, resulting in the development of Wernicke's encephalopathy (WE). This article describes the rapid onset of WE in a 6-week postoperative morbidly obese woman. Because the occurrence of micronutrient deficiencies is infrequent, although reports are increasing, symptoms may be misdiagnosed leading to possible irreversible effects on the central nervous system. The importance of a prompt diagnosis of this serious complication and of adequate therapy is emphasized.
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PMID:Wernicke's encephalopathy after Roux-en-Y gastric bypass. 1547 7

Wernicke's encephalopathy is a common complication of thiamine deficiency among alcoholics. However, there are few reports of this disorder in non-alcoholics. We present a case of Wernicke's encephalopathy in a non-alcoholic, 68-year-old patient with recurrent vomiting attributed to biliary colics. Establishing the diagnosis in this patient was complicated by our finding of positive 14-3-3 protein in the cerebrospinal fluid (CSF). This is typically elevated in prion disease, but it has not previously been reported to be elevated in this entity. Compatible clinical presentation in combination with typical magnetic resonance imaging (MRI) findings and exclusion of other possible causes finally established the diagnosis.
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PMID:Non-alcoholic Wernicke's encephalopathy - unusual clinical findings. 1619 7

We report a clinical and neuroradiological description of a severe case of Wernicke's encephalopathy in a surgical patient. After colonic surgery for neoplasm, he was treated for a long time with high glucose concentration total parenteral nutrition. In the early post-operative period, the patient showed severe encephalopathy with ataxia, ophthalmoplegia and consciousness disorders. We used magnetic resonance imaging (MRI) to confirm the clinical suspicion of Wernicke's encephalopathy. The radiological feature showed hyperintense lesions which were symmetrically distributed along the bulbo-pontine tegmentum, the tectum of the mid-brain, the periacqueductal grey substance, the hypothalamus and the medial periventricular parts of the thalamus. This progressed to typical Wernicke-Korsakoff syndrome with ataxia and memory and cognitive defects. Thiamine deficiency is a re-emerging problem in non-alcoholic patients and it may develop in surgical patients with risk factors such as malnutrition, prolonged vomiting and long-term high glucose concentration parenteral nutrition.
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PMID:Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging. 1622 8

Wernicke encephalopathy (WE) is a rare but known complication of severe hyperemesis gravidarum caused by thiamine deficiency. This article presents an unusual case that occurred at our institution and reviews the 48 previously published cases of WE in pregnancy. Considering all the 49 cases, the mean (+/-standard deviation) patients' age was 26.7 +/- 4.9 years, the mean gestational age when WE manifested was 14.3 +/- 3.4 weeks, and the mean duration of vomiting and feeding difficulties was 7.7 +/- 2.8 weeks. Wernicke's classic triad (confusion, ocular abnormalities, and ataxia) manifested in only 46.9% (23 of 49) of the patients. Confusion affected 63.3% (31 of 49) of the patients, ocular signs 95.9% (47 of 49) and symptoms 57.1% (28 of 49), and ataxia 81.6% (40 of 49). Deterioration of consciousness affected 53.1% (26 of 49) of the subjects and memory impairment 61.2% (30 of 49). Complete remission of the disease occurred in only 14 of 49 cases. Symptom resolution required months and permanent impairments were common. The overall pregnancy loss rate, directly (spontaneous fetal loss) and indirectly (planned abortion) attributable to WE, was 47.9% (23 of 49). The diagnosis of WE is clinical and can be rapidly confirmed by magnetic resonance imaging. We emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy, especially before intravenous or parenteral nutrition. We also underline the necessity to promptly replace vitamin B1 when neurologic symptoms and/or signs develop in a patient with hyperemesis gravidarum.
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PMID:Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. 1655 77

A 42-year-old man presented in the Department of Ophthalmology of Holstebro Central Hospital with a history of alcohol abuse, vomiting and weight loss. The initial symptoms of beriberi were stiffness of the legs and a picture of Wernicke's syndrome. He had bilateral loss of horizontal eccentric gaze holding and upbeat nystagmus, and visual acuity was reduced to counting fingers. Visual acuity was tested in the down-gaze position and increased to 0.3 because of reduced nystagmus. The patient's oculomotor function improved dramatically after treatment with thiamine. Wernicke's encephalopathy and beriberi are discussed, highlighting that nystagmus may be the single ocular symptom. It should be considered in the differential diagnosis of bilateral ophthalmoplegia even in the absence of altered mental status.
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PMID:[Reduced vision in Wernicke's syndrome with symptoms of nystagmus]. 1658 77


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