User:MRH2002!/Wernicke encephalopathy
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Pathological anatomy[edit]
Despite its name, WE is not related to Wernicke's area, a region of the brain associated with speech and language interpretation.
Brain lesions in WE are usually credited to focal lactic acidosis. An absence of thiamine can lead to too much pyruvate within the cells since it's not available to help convert pyruvate through the TCA cycle. An increase in pyruvate causes an increase in lactate concentration leading to focal lactic acidosis.[1]
Lesions can be reversed in most cases with immediate supplementation of thiamine.
Lesions are usually symmetrical in the periventricular region, diencephalon, midbrain, hypothalamus, and cerebellar vermis. Brainstem lesions may include cranial nerve III, IV, VI, and VIII nuclei, the medial thalamic nuclei, and the dorsal nucleus of the vagus nerve. Oedema may be found in the regions surrounding the third ventricle, and the fourth ventricle, also appearing as petechiae and small hemorrhages.[2] Chronic cases can present the atrophy of the mammillary bodies.[3]
In 1949, the idea that WE lesions are a result of a disruption to the blood-brain barrier was introduced.[1] Large proteins passing into the brain can put neurological tissue at risk of toxic effects. The blood-brain barrier junctions are typically found to have WE lesions located at that region of the brain.[1]
An altered blood–brain barrier may cause a perturbed response to certain drugs and foods.[4]
Epidemiology[edit]
Wernicke's lesions were observed in 0.8 to 2.8% of the general population autopsies, and 12.5% of people with an alcohol use disorder. This figure increases to 35% of such individuals if including cerebellar damage due to lack of thiamine.[5]
Most autopsy cases were from people with an alcohol use disorder. Autopsy series were performed in hospitals on the material available which is unlikely to be representative of the entire population. Considering the slight affectations, previous to the generation of observable lesions at necropsy, the percentage should be higher. There is evidence to indicate that Wernicke encephalopathy is underdiagnosed.[6][7] For example, in one 1986 study, 80% of cases were diagnosed postmortem.[6] Is estimated that only 5–14% of patients with WE are diagnosed in life.[5][8]
In a series of autopsy studies held in Recife, Brazil, it was found that only 7 out of 36 had consumed excessive amounts of alcohol, and only a small minority had malnutrition.[9] In a review of 53 published case reports from 2001 to 2011, the relationship with alcohol was also about 20% (10 out of 53 cases).[10]
WE related to alcohol misuse is more common in males and is more common in females when not related to alcohol misuse.[11] In alcohol-related cases, WE patients average the age of 40, and non-alcohol-related cases typically occur in younger people.[11]
History[edit]
WE was first identified in 1881 by the German neurologist Carl Wernicke, although the link with thiamine was not identified until the 1930s.
Carl Wernicke discovered the sensory center of speech. Wernicke figured out that Broca’s area was not the only center of speech, it was also able to distinguish motor aphasia from sensory aphasia.[12] He also pointed to the possibility of conduction aphasia since he came to understand the arrangement of the brain’s extrinsic and intrinsic connections. He demonstrated that the sensory information reached its corresponding area in the cerebral cortex through projection fibers. From there, this information, following the association system, would be distributed to different regions of the cortex, integrating sensory processing. [12]
He reported three patients with WE, including two men (aged 33 and 36) who were alcoholics and one woman (aged 20) who ingested sulfuric acid, leading to pyloric stenosis. All three had ocular motor abnormalities and he performed an autopsy on each, providing a clinical-pathological correlation.[13]
A similar presentation of this disease was described by the Russian psychiatrist Sergei Korsakoff in a series of articles published 1887–1891; [14] where the chronic version of WE was described as Korsakoff's Syndrome, involving symptoms of amnesia.[15][16][17]
References[edit]
- ^ a b c Kohnke, Sara; Meek, Claire L (2021-01). "Don't seek, don't find: The diagnostic challenge of Wernicke's encephalopathy". Annals of Clinical Biochemistry: International Journal of Laboratory Medicine. 58 (1): 38–46. doi:10.1177/0004563220939604. ISSN 0004-5632. PMC 7791272. PMID 32551830.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ Powell SZ, Schochet Jr SS (March 2003). "Intoxications and Metabolic Diseases of the Central Nervous System". In Nelson JS, Mena H, Parisi JE, Schochet SS (eds.). Principles and Practice of Neuropathology. Oxford University Press. p. 193. ISBN 978-0-19-802907-6.
- ^ Zuccoli G, Pipitone N (February 2009). "Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature". AJR. American Journal of Roentgenology. 192 (2): 501–508. doi:10.2214/AJR.07.3959. PMID 19155417. S2CID 32749934.
- ^ Cernicchiaro L (September 2017). "Wernicke´s Disease (or Wernicke´s Encephalopathy). Symptoms and new treatments. Clinical and practical approach. Daily monitoring for twelve years of a reversed severe case". [self-published source?][unreliable medical source?]
- ^ a b Torvik A, Lindboe CF, Rogde S (November 1982). "Brain lesions in alcoholics. A neuropathological study with clinical correlations". Journal of the Neurological Sciences. 56 (2–3): 233–48. doi:10.1016/0022-510x(82)90145-9. PMID 7175549. S2CID 26100578.
- ^ a b Harper CG, Giles M, Finlay-Jones R (April 1986). "Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy". Journal of Neurology, Neurosurgery, and Psychiatry. 49 (4): 341–345. doi:10.1136/jnnp.49.4.341. PMC 1028756. PMID 3701343.
- ^ Harper C (March 1979). "Wernicke's encephalopathy: a more common disease than realised. A neuropathological study of 51 cases". Journal of Neurology, Neurosurgery, and Psychiatry. 42 (3): 226–231. doi:10.1136/jnnp.42.3.226. PMC 490724. PMID 438830.
- ^ Blansjaar BA, Van Dijk JG (July 1992). "Korsakoff minus Wernicke syndrome". Alcohol and Alcoholism (Oxford, Oxfordshire). 27 (4): 435–7. doi:10.1093/oxfordjournals.alcalc.a045269. PMID 1418116.
- ^ Lana-Peixoto MA, Dos Santos EC, Pittella JE (September 1992). "Coma and death in unrecognized Wernicke's encephalopathy. An autopsy study". Arquivos de Neuro-Psiquiatria. 50 (3): 329–333. doi:10.1590/S0004-282X1992000300012. PMID 1308411.
- ^ Lough ME (June 2012). "Wernicke's encephalopathy: expanding the diagnostic toolbox". Neuropsychology Review. 22 (2): 181–194. doi:10.1007/s11065-012-9200-7. PMID 22577001. S2CID 18884274.
- ^ a b Kohnke, Sara; Meek, Claire L (2021-01). "Don't seek, don't find: The diagnostic challenge of Wernicke's encephalopathy". Annals of Clinical Biochemistry: International Journal of Laboratory Medicine. 58 (1): 38–46. doi:10.1177/0004563220939604. ISSN 0004-5632. PMC 7791272. PMID 32551830.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ a b Bem Junior, Luiz Severo; Lemos, Nilson Batista; de Lima, Luís Felipe Gonçalves; Dias, Artêmio José Araruna; Neto, Otávio da Cunha Ferreira; de Lira, Carlos Cezar Sousa; Diniz, Andrey Maia Silva; Rabelo, Nicollas Nunes; Barroso, Luciana Karla Viana; Valença, Marcelo Moraes; de Azevedo Filho, Hildo Rocha Cirne (2021-06-28). "The anatomy of the brain – learned over the centuries". Surgical Neurology International. 12: 319. doi:10.25259/SNI_200_2021. ISSN 2152-7806. PMC 8326080. PMID 34345460.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Isen, Danielle R.; Kline, Lanning B. (2020-06-30). "Neuro-ophthalmic Manifestations of Wernicke Encephalopathy". Eye and Brain. 12: 49–60. doi:10.2147/EB.S234078. PMC 7335288. PMID 32636690.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Lough ME (June 2012). "Wernicke's encephalopathy: expanding the diagnostic toolbox". Neuropsychology Review. 22 (2): 181–194. doi:10.1007/s11065-012-9200-7. PMID 22577001. S2CID 18884274.
- ^ Isenberg-Grzeda E, Kutner HE, Nicolson SE (2012-11-01). "Wernicke-Korsakoff-syndrome: under-recognized and under-treated". Psychosomatics. 53 (6): 507–516. doi:10.1016/j.psym.2012.04.008. PMID 23157990.
- ^ Sechi G, Serra A (May 2007). "Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management". The Lancet. Neurology. 6 (5): 442–455. doi:10.1016/S1474-4422(07)70104-7. PMID 17434099. S2CID 15523083.
- ^ Oudman E, Wijnia JW, Oey MJ, van Dam M, Postma A (July 2021). "Wernicke-Korsakoff syndrome despite no alcohol abuse: A summary of systematic reports". Journal of the Neurological Sciences. 426: 117482. doi:10.1016/j.jns.2021.117482. PMID 34000679. S2CID 234769882.