Treatment of Nasopharyngeal Carcinoma and Prevention of Non-alcoholic Wernicke's Disease: A Case Report and Review of Literature

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2024 Aug 27

PMID 39188614

Authors

Yu-Yang Ma

Xiao-Chan He

Yu Gao

Tian-Tian Ma

Gong Cheng

Chang-Wu Yue

Affiliations

Soon will be listed here.

Abstract

Background: Wernicke encephalopathy is a neurological disorder caused by thiamine deficiency, commonly seen in alcoholic populations but also involving other circumstances that may lead to thiamine deficiency. The recognition of Wernicke encephalopathy often depends on clinicians' keen ability to detect its typical triad of features; however, most cases do not present with the full constellation of signs, which complicates the timely identification of Wernicke encephalopathy.

Case Summary: This case report describes a patient with nasopharyngeal carcinoma who developed abnormal ocular function and ataxia following concurrent chemoradiotherapy, without a history of alcohol abuse. With the aid of radiological examinations, he received a timely diagnosis and treatment; however, his symptoms did not fully resolve during follow-up.

Conclusion: For patients with malignant tumors exhibiting neurological symptoms, clinicians should consider the possibility of Wernicke encephalopathy and provide prophylactic thiamine therapy.

References

Gagnier J, Kienle G, Altman D, Moher D, Sox H, Riley D . The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob Adv Health Med. 2014; 2(5):38-43. PMC: 3833570. DOI: 10.7453/gahmj.2013.008. View

Sechi G, Serra A . Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5):442-55. DOI: 10.1016/S1474-4422(07)70104-7. View

Sinha S, Kataria A, Kolla B, Thusius N, Loukianova L . Wernicke Encephalopathy-Clinical Pearls. Mayo Clin Proc. 2019; 94(6):1065-1072. DOI: 10.1016/j.mayocp.2019.02.018. View

Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A . MR imaging findings in alcoholic and nonalcoholic acute Wernicke's encephalopathy: a review. Biomed Res Int. 2014; 2014:503596. PMC: 4094710. DOI: 10.1155/2014/503596. View

Galvin R, Brathen G, Ivashynka A, Hillbom M, Tanasescu R, Leone M . EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010; 17(12):1408-18. DOI: 10.1111/j.1468-1331.2010.03153.x. View

Whitfield K, Bourassa M, Adamolekun B, Bergeron G, Bettendorff L, Brown K . Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs. Ann N Y Acad Sci. 2018; 1430(1):3-43. PMC: 6392124. DOI: 10.1111/nyas.13919. View

Isenberg-Grzeda E, Hsu A, Hatzoglou V, Nelso C, Breitbart W . Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliat Support Care. 2014; 13(5):1241-9. PMC: 4982657. DOI: 10.1017/S1478951514001163. View

Rasiah R, Gregoriano C, Mueller B, Kutz A, Schuetz P . Hospital Outcomes in Medical Patients With Alcohol-Related and Non-Alcohol-Related Wernicke Encephalopathy. Mayo Clin Proc. 2023; 99(5):740-753. DOI: 10.1016/j.mayocp.2023.07.021. View

Tang L, Guo R, Zhang N, Deng B, Chen L, Cheng Z . Effect of Radiotherapy Alone vs Radiotherapy With Concurrent Chemoradiotherapy on Survival Without Disease Relapse in Patients With Low-risk Nasopharyngeal Carcinoma: A Randomized Clinical Trial. JAMA. 2022; 328(8):728-736. PMC: 9399866. DOI: 10.1001/jama.2022.13997. View

10.

Chua M, Wee J, Hui E, Chan A . Nasopharyngeal carcinoma. Lancet. 2015; 387(10022):1012-1024. DOI: 10.1016/S0140-6736(15)00055-0. View

11.

Dingwall K, Delima J, Binks P, Batey R, Bowden S . What is the optimum thiamine dose to treat or prevent Wernicke's encephalopathy or Wernicke-Korsakoff syndrome? Results of a randomized controlled trial. Alcohol Clin Exp Res. 2022; 46(6):1133-1147. PMC: 9321884. DOI: 10.1111/acer.14843. View

12.

Jung Y, Chanraud S, Sullivan E . Neuroimaging of Wernicke's encephalopathy and Korsakoff's syndrome. Neuropsychol Rev. 2012; 22(2):170-80. PMC: 4728174. DOI: 10.1007/s11065-012-9203-4. View

13.

Luong K, Nguyn L . The role of thiamine in cancer: possible genetic and cellular signaling mechanisms. Cancer Genomics Proteomics. 2013; 10(4):169-85. View

14.

Isenberg-Grzeda E, Rahane S, DeRosa A, Ellis J, Nicolson S . Wernicke-Korsakoff syndrome in patients with cancer: a systematic review. Lancet Oncol. 2016; 17(4):e142-e148. DOI: 10.1016/S1470-2045(16)00037-1. View

15.

Harding A, Halliday G, Caine D, Kril J . Degeneration of anterior thalamic nuclei differentiates alcoholics with amnesia. Brain. 1999; 123 ( Pt 1):141-54. DOI: 10.1093/brain/123.1.141. View

16.

Restivo A, Carta M, Farci A, Saiu L, Gessa G, Agabio R . Risk of thiamine deficiency and Wernicke's encephalopathy after gastrointestinal surgery for cancer. Support Care Cancer. 2015; 24(1):77-82. DOI: 10.1007/s00520-015-2748-z. View

17.

Ota Y, Capizzano A, Moritani T, Naganawa S, Kurokawa R, Srinivasan A . Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol. 2020; 38(9):809-820. DOI: 10.1007/s11604-020-00989-3. View

18.

Oudman E, Wijnia J, Oey M, van Dam M, Postma A . Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review. Psychiatry Clin Neurosci. 2018; 72(10):774-779. DOI: 10.1111/pcn.12735. View

19.

Chen Y, Chan A, Le Q, Blanchard P, Sun Y, Ma J . Nasopharyngeal carcinoma. Lancet. 2019; 394(10192):64-80. DOI: 10.1016/S0140-6736(19)30956-0. View

20.

Onishi H, Ishida M, Kagamu H, Murayama Y, Kobayashi K, Sato I . Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliat Support Care. 2018; 17(2):245-247. DOI: 10.1017/S1478951518000469. View