was read the article
array:24 [ "pii" => "S2173580818301810" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2018.11.005" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1022" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2019;34:543-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 513 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 319 "PDF" => 155 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485317300233" "issn" => "02134853" "doi" => "10.1016/j.nrl.2017.01.002" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1022" "copyright" => "The Authors" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2019;34:543-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1514 "formatos" => array:3 [ "EPUB" => 61 "HTML" => 970 "PDF" => 483 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Desnutrición en el anciano y encefalopatía de Wernicke" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "543" "paginaFinal" => "546" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Malnutrition in the elderly and Wernicke encephalopathy" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1085 "Ancho" => 1350 "Tamanyo" => 222806 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">EEG en el que se observa una actividad de base lenta.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Ros Forteza, H. Cabrera, M. Bousende" "autores" => array:3 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Ros Forteza" ] 1 => array:2 [ "nombre" => "H." "apellidos" => "Cabrera" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Bousende" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580818301810" "doi" => "10.1016/j.nrleng.2018.11.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580818301810?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317300233?idApp=UINPBA00004N" "url" => "/02134853/0000003400000008/v1_201909271646/S0213485317300233/v1_201909271646/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580818301809" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2017.01.007" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1019" "copyright" => "The Author(s)" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2019;34:546-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 192 "formatos" => array:3 [ "EPUB" => 31 "HTML" => 100 "PDF" => 61 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "New mutation in a patient with Charcot-Marie-Tooth disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "546" "paginaFinal" => "547" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nueva mutación genética en un caso de enfermedad de Charcot-Marie-Tooth" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Domínguez Díez, J.T. López Alburquerque" "autores" => array:2 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Domínguez Díez" ] 1 => array:2 [ "nombre" => "J.T." "apellidos" => "López Alburquerque" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317300208" "doi" => "10.1016/j.nrl.2017.01.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317300208?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580818301809?idApp=UINPBA00004N" "url" => "/21735808/0000003400000008/v1_201909271459/S2173580818301809/v1_201909271459/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580819300124" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2019.01.006" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1052" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Neurologia. 2019;34:536-42" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 695 "formatos" => array:3 [ "EPUB" => 56 "HTML" => 501 "PDF" => 138 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "536" "paginaFinal" => "542" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de cefalea transitoria con déficits neurológicos asociados y pleocitosis en líquido cefalorraquídeo (HaNDL) con cuadro confusional, EEG compatible con afectación difusa y datos de vasoespasmo bilateral en estudio Doppler transcraneal: presentación de un caso y revisión de la literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1495 "Ancho" => 2000 "Tamanyo" => 574854 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Follow-up SPECT scan performed 2 months after symptom resolution: improved cortical perfusion; mild-to-moderate temporoparietal hypoperfusion persists bilaterally.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Hidalgo de la Cruz, R. Domínguez Rubio, E. Luque Buzo, F. Díaz Otero, P. Vázquez Alén, J. Orcajo Rincón, J. Prieto Montalvo, A. Contreras Chicote, F. Grandas Pérez" "autores" => array:9 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Hidalgo de la Cruz" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Domínguez Rubio" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Luque Buzo" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Díaz Otero" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Vázquez Alén" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Orcajo Rincón" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "Prieto Montalvo" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Contreras Chicote" ] 8 => array:2 [ "nombre" => "F." "apellidos" => "Grandas Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317301469" "doi" => "10.1016/j.nrl.2017.02.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317301469?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580819300124?idApp=UINPBA00004N" "url" => "/21735808/0000003400000008/v1_201909271459/S2173580819300124/v1_201909271459/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Malnutrition and Wernicke encephalopathy in the elderly" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "543" "paginaFinal" => "546" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.J. Ros Forteza, H. Cabrera, M. Bousende" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Ros Forteza" "email" => array:1 [ 0 => "javierros40@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "H." "apellidos" => "Cabrera" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Bousende" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Serviço de Neurologia, Unidade Local de Saúde da Guarda, EPE, Guarda, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Ciências Médicas, Faculdade de Ciências da Saúde (UBI), Covilhã, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Medicina Interna, ULS-Guarda, EPE, Guarda, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Serviço de Neurorradiologia, Centro Hospitalar São João, EPE, Porto, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desnutrición en el anciano y encefalopatía de Wernicke" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1503 "Ancho" => 1675 "Tamanyo" => 316401 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Baseline findings</span>: (A) Head CT at 24<span class="elsevierStyleHsp" style=""></span>hours: hypodensity in the right tectal plate. (B) Axial T2-weighted MRI sequence. (C) Axial FLAIR MRI sequence: lesion to the midbrain periaqueductal region. (D) Axial FLAIR MRI sequence: bilateral thalamic lesions. (E) Axial FLAIR MRI sequence: tectal lesion. (F) Sagittal T1-weighted MRI sequence: no alterations. (G) Axial FLAIR MRI sequence: lesion to the superior frontal cortex and pia mater. <span class="elsevierStyleItalic">Findings at resolution:</span> (H) Axial T2-weighted MRI sequence: regressing periaqueductal lesion. (I) Axial FLAIR MRI sequence: no thalamic lesion. (J) Axial FLAIR MRI sequence: no bulbar lesion. (K) Axial FLAIR MRI sequence: no lesion to the cortex or pia mater.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Wernicke encephalopathy (WE) is the main neurological disorder caused by deficiency of the cofactor thiamine, which is crucial in energy metabolism; magnesium is also involved as a thiamine cofactor.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> WE can be alcoholic or non-alcoholic<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> (caused by malnutrition or increased water-soluble vitamin loss, as in dialysis). Prevalence of WE lesions in autopsy studies has been reported to be 12.5% in alcoholics<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> and 30% to 60% in alcohol-related fatalities.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4,5</span></a> WE is a little-recognised and underdiagnosed condition. Although WE is more prevalent in men, women are more susceptible.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6,7</span></a> Diagnosis is clinical and early treatment is fundamental in preventing coma and death.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 81-year-old woman (height 1.58<span class="elsevierStyleHsp" style=""></span>m, weight 58<span class="elsevierStyleHsp" style=""></span>kg, BMI 23.2), who was autonomous in the activities of daily living before symptom onset.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Her personal history included 10 years of schooling, no history of alcohol abuse, hypertension, hiatal hernia diagnosed 18 years previously, anti-reflux surgery 15 years previously, cholecystectomy, and acute biliary pancreatitis. She was being treated with pantoprazole, domperidone, ursodeoxycholic acid, candesartan, mexazolam, mirtazapine, and brotizolam.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Two to 3 weeks after an influenza episode, she developed anorexia, dehydration, mental confusion, altered sleep-wake cycle, and visual and gait impairment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Physical examination revealed somnolence, disorientation in time but not space, incoherent speech, strabismus, persistent horizontal-rotary nystagmus, dysphagia for liquids, and hypotonia. The patient was haemodynamically stable, with normal results in the cardiopulmonary auscultation and sinus rhythm in the electrocardiography. Blood analysis revealed no anaemia or leukocytosis and a normal level of C-reactive protein. Urine benzodiazepine levels were twice the normal value. Head CT scan findings were normal but at 24<span class="elsevierStyleHsp" style=""></span>hours she presented a suspected lacunar stroke of the right tectal plate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), requiring examination with brain MRI. A transthoracic echocardiography did not detect cardioembolism, and lumbar puncture returned normal results.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">She started treatment with thiamine at high doses (500<span class="elsevierStyleHsp" style=""></span>mg IV every 8<span class="elsevierStyleHsp" style=""></span>hours for 2 days, 500<span class="elsevierStyleHsp" style=""></span>mg IV every 24<span class="elsevierStyleHsp" style=""></span>hours for 5 days), then at 100<span class="elsevierStyleHsp" style=""></span>mg IV every 8<span class="elsevierStyleHsp" style=""></span>hours during the remaining days of hospitalisation, combined with a multivitamin solution (vitamin A, B, H [biotin], and F) and protein-calorie supplementation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">She was initially admitted to the stroke unit to rule out brainstem stroke. We observed a significant clinical improvement, with decreased nystagmus, improved verbal expression, and corrected sleep pattern. A brain MRI (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B-G) performed at day 5 of admission revealed diffuse hyperintensity of the tectum, periaqueductal region, medial thalami, mammillary bodies, and structures adjacent to the diencephalon and cortical convexity with brain atrophy; these findings are indicative of WE.</p><p id="par0040" class="elsevierStylePara elsevierViewall">At day 6 of admission, the patient was transferred to the neurology department. She was awake, with no spontaneous verbal response, strabismus (exotropia of the right eye), isochoric and reactive pupils (preserved photomotor and consensual reflexes), and mild horizontal-rotatory nystagmus. The patient presented no motor deficit and did not collaborate in the examination. Enteral feeding via nasogastric tube was continued; the patient's body weight was 39<span class="elsevierStyleHsp" style=""></span>kg (BMI: 15.6).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The examination revealed a haemoglobin level of 7.8<span class="elsevierStyleHsp" style=""></span>g/dL; haematocrit, 24% (normal range, 36-46); vitamin B<span class="elsevierStyleInf">1</span>, 27<span class="elsevierStyleHsp" style=""></span>ng/mL (28-85); vitamin B<span class="elsevierStyleInf">12</span>, 158<span class="elsevierStyleHsp" style=""></span>pg/mL (187-883); vitamin D, 17<span class="elsevierStyleHsp" style=""></span>ng/mL (30-100); magnesium, 1.37<span class="elsevierStyleHsp" style=""></span>mg/dL (1.6-2.6); sodium, 135<span class="elsevierStyleHsp" style=""></span>mg/dL (136-145); proteins, 5.3<span class="elsevierStyleHsp" style=""></span>g/dL (6.4-8.3), and albumin, 2.9<span class="elsevierStyleHsp" style=""></span>g/dL (3.2-4.6). Results of the analysis of MCV and MCH (red blood cells), folic acid, ammonia, thyroid function, and calcium and phosphate metabolism were normal. Intrinsic factor antibody test and serological test for syphilis yielded negative results.</p><p id="par0050" class="elsevierStylePara elsevierViewall">She received a transfusion of 1<span class="elsevierStyleHsp" style=""></span>U of red blood cells; thiamine was maintained at 100<span class="elsevierStyleHsp" style=""></span>mg IV every 8<span class="elsevierStyleHsp" style=""></span>hours; pantoprazole was withdrawn and ranitidine started at 150<span class="elsevierStyleHsp" style=""></span>mg at night. The patient also started treatment with oral vitamin B<span class="elsevierStyleInf">12</span> at 5<span class="elsevierStyleHsp" style=""></span>mg/day, cholecalciferol 667<span class="elsevierStyleHsp" style=""></span>IU/day, magnesium 10<span class="elsevierStyleHsp" style=""></span>mL/12<span class="elsevierStyleHsp" style=""></span>h, calcium carbonate 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h, and 0.9% saline solution.</p><p id="par0055" class="elsevierStylePara elsevierViewall">During the first 2 weeks of progression, her speech improved and she was able to produce sentences; nystagmus manifested only at extreme lateral gaze. Ataxic gait was later identified and she started rehabilitation.</p><p id="par0060" class="elsevierStylePara elsevierViewall">At one month of progression, we performed an awake EEG (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which revealed slow background activity, suggesting diffuse brain dysfunction (grades 2-3). Vitamin B<span class="elsevierStyleInf">1</span> level was 193<span class="elsevierStyleHsp" style=""></span>ng/mL. The patient was transferred to another institution for recovery and continued with feeding via nasogastric tube.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">From the second month of treatment, our patient presented good general appearance, fluent and coherent speech, an MMSE score of 23 (4 in orientation, 3 in registration, 4 in attention and calculation, 3 in recall, and 9 in language and copying); she was self-critical, interacted with her family, and could walk only with assistance. She needed help eating and with personal care. The patient participated in craft activities and regular rehabilitation sessions.</p><p id="par0070" class="elsevierStylePara elsevierViewall">At 3 months, a significant improvement was observed in her nutritional status and she walked with a walker; a brain MRI scan revealed complete remission of the brain lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>H-K).</p><p id="par0075" class="elsevierStylePara elsevierViewall">The neuropsychological evaluation showed that autobiographical memory was preserved. We were able to apply only 3 subtests of the Wechsler Adult Intelligence Scale (WAIS-III): matrix reasoning, similarities, and digit span; results were higher level, average level, and average level, respectively. No areas of deficit were identified.</p><p id="par0080" class="elsevierStylePara elsevierViewall">WE should be considered in the differential diagnosis of all patients with delirium<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> or acute ataxia. Structural diseases of the medial thalamus, hippocampus, or the inferior medial region of the temporal lobe should also be considered due to the similar neuroanatomical involvement to WE. These include top of the basilar syndrome, hypoxic-ischaemic encephalopathy following cardiac arrest, herpes simplex encephalitis, and third ventricle tumour.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Age of onset in our patient is atypical (eighth decade of life); she presented the classic triad of WE (encephalopathy, oculomotor dysfunction, and ataxia), although it was not observed at admission. In this case, WE was severe and was caused by malnutrition.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> She lost 33% of her body weight, with a BMI of 15.6 (BMI below 16 corresponds to grade 3/severe thinness according to the WHO classifications [1995,2000]).</p><p id="par0090" class="elsevierStylePara elsevierViewall">Protein-calorie deficiency is not always present; in a review of 625 cases reported in the literature, the cause of WE was fasting or malnutrition in 10.2% of cases.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Brain MRI showed the characteristic findings of WE, but this test is more sensitive for detecting WE lesions in non-alcoholic than in alcoholic patients<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a>; clinical progression was excellent with vitamin supplementation.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the pathophysiology of these symptoms, thiamine reserves were depleted in 2-3 weeks due to caloric restriction. In the event of thiamine depletion, the function of the thiamine-dependent enzyme systems deteriorates and blood thiamine levels decrease. This damage occurs 4 days after onset of thiamine deficiency and eventually progresses to programmed cell death. At 14 days, brain lesions develop.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> It is probable that some subjects with genetically reduced transkelotase activity require higher levels of thiamine and therefore present a higher risk of WE in situations of increased demand or lower absorption.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> The low level of magnesium (a thiamine cofactor) also helped in the development of the disease. Other associated factors were vitamin B<span class="elsevierStyleInf">12</span> deficiency (long-term use of pantoprazole suppresses gastric acid production, which may lead to vitamin B<span class="elsevierStyleInf">12</span> malabsorption<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>), and vitamin D and albumin deficiency.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Our case is interesting as despite the several weeks of progression with altered mental state, vision, and gait, the first diagnostic hypothesis was vertebrobasilar stroke. Furthermore, WE was diagnosed in a context of severe malnutrition in a non-alcoholic patient, despite symptoms and neuroimaging findings being more typical of an alcoholic patient.</p><p id="par0110" class="elsevierStylePara elsevierViewall">We propose that WE should be considered in patients of advanced age with altered level of consciousness of unknown cause, even in non-alcoholic patients; infusion of thiamine should be started immediately when the disorder is suspected, even in the absence of typical symptoms.</p><p id="par0115" class="elsevierStylePara elsevierViewall">With this case, we aim to raise awareness of the need to identify this preventable, treatable, and high-mortality disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ros Forteza FJ, Cabrera H, Bousende M. Desnutrición en el anciano y encefalopatía de Wernicke. Neurología. 2019;34:543–546.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1503 "Ancho" => 1675 "Tamanyo" => 316401 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Baseline findings</span>: (A) Head CT at 24<span class="elsevierStyleHsp" style=""></span>hours: hypodensity in the right tectal plate. (B) Axial T2-weighted MRI sequence. (C) Axial FLAIR MRI sequence: lesion to the midbrain periaqueductal region. (D) Axial FLAIR MRI sequence: bilateral thalamic lesions. (E) Axial FLAIR MRI sequence: tectal lesion. (F) Sagittal T1-weighted MRI sequence: no alterations. (G) Axial FLAIR MRI sequence: lesion to the superior frontal cortex and pia mater. <span class="elsevierStyleItalic">Findings at resolution:</span> (H) Axial T2-weighted MRI sequence: regressing periaqueductal lesion. (I) Axial FLAIR MRI sequence: no thalamic lesion. (J) Axial FLAIR MRI sequence: no bulbar lesion. (K) Axial FLAIR MRI sequence: no lesion to the cortex or pia mater.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1085 "Ancho" => 1350 "Tamanyo" => 222806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">EEG showing slow background activity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wernicke's encephalopathy induced by magnesium deplection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Mclean" 1 => "S. Manchip" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Lancet" "fecha" => "1999" "volumen" => "353" "paginaInicial" => "1768" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0080" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wernicke's encephalopathy in non-alcoholics. An autopsy study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.F. Lindboe" 1 => "E.M. Løberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0022-510x(89)90095-6" "Revista" => array:6 [ "tituloSerie" => "J Neurol Sci" "fecha" => "1989" "volumen" => "90" "paginaInicial" => "125" "paginaFinal" => "129" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2723677" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0085" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brain lesions in alcoholics. A neuropathological study with clinical correlations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Torvik" 1 => "C.F. Lindboe" 2 => "S. Rogde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0022-510x(82)90145-9" "Revista" => array:6 [ "tituloSerie" => "J Neurol Sci" "fecha" => "1982" "volumen" => "56" "paginaInicial" => "233" "paginaFinal" => "248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7175549" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0090" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autopsy prevalence of Wernicke's encephalopathy in alcohol-related disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.P. Naidoo" 1 => "A. Bramdev" 2 => "K. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "S Afr Med J" "fecha" => "1996" "volumen" => "86" "paginaInicial" => "1110" "paginaFinal" => "1112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8888781" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0095" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral lesions and causes of death in male alcoholics. A forensic autopsy study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Skullerud" 1 => "S.N. Andersen" 2 => "J. Lundevall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Legal Med" "fecha" => "1991" "volumen" => "104" "paginaInicial" => "209" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1931737" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0100" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Wernicke-Korsakoff syndrome and related disorders due to alcoholism and malnutrition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Victor" 1 => "R.A. Adams" 2 => "G.H. Collins" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1989" "editorial" => "Fa Davis" "editorialLocalizacion" => "Philadelphia, PA" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0105" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence of Wernicke's encephalopathy in Australia-a neuropathological study of 131 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Harper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/jnnp.46.7.593" "Revista" => array:6 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "1983" "volumen" => "46" "paginaInicial" => "593" "paginaFinal" => "598" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6886695" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0110" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thiamine deficiency in hospitalized elderly patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.T. O’Keeffe" 1 => "W.P. Tormey" 2 => "R. Glasgow" 3 => "J.N. Lavan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000213570" "Revista" => array:6 [ "tituloSerie" => "Gerontology" "fecha" => "1994" "volumen" => "40" "paginaInicial" => "18" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8034199" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0115" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute Korsakof syndrome following mammillothalamic tract infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Yoneoka" 1 => "N. Takeda" 2 => "A. Inoue" 3 => "Y. Ibuchi" 4 => "T. Kumagai" 5 => "T. Sugai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "964" "paginaFinal" => "968" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15205131" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0120" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pure and acute Korsakof syndrome due to a bilateral anterior fornix infarction: a diffusion tensor tractography study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Renou" 1 => "D. Ducreux" 2 => "F. Batouche" 3 => "C. Denier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archneur.65.9.1252" "Revista" => array:5 [ "tituloSerie" => "Arch Neurol" "fecha" => "2008" "volumen" => "65" "paginaInicial" => "1252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18779434" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0125" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malnutrition-induced Wernicke's encephalopathy following a water-only fasting diet" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.A. Hutcheon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0884533614561793" "Revista" => array:6 [ "tituloSerie" => "Nutr Clin Pract" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "92" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25524882" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0130" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Galvin" 1 => "G. Brathen" 2 => "A. Ivashynka" 3 => "M. Hillbom" 4 => "R. Tanasescu" 5 => "M.A. Leone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-1331.2010.03153.x" "Revista" => array:6 [ "tituloSerie" => "Eur J Neurol" "fecha" => "2010" "volumen" => "17" "paginaInicial" => "1408" "paginaFinal" => "1418" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20642790" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0135" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Encefalopatía de Wernicke en pacientes no alcohólicos: una serie de 8 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Gascón-Bayarri" 1 => "J. Campdelacreu" 2 => "M.C. García-Carreira" 3 => "J. Estela" 4 => "S. Martínez-Yélamos" 5 => "A. Palasí" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nrl.2011.03.001" "Revista" => array:6 [ "tituloSerie" => "Neurologia" "fecha" => "2011" "volumen" => "26" "paginaInicial" => "540" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21565430" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0140" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B<span class="elsevierStyleInf">12</span> deficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.R. Lam" 1 => "J.L. Schneider" 2 => "W. Zhao" 3 => "D.A. Corley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2013.280490" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "310" "paginaInicial" => "2435" "paginaFinal" => "2442" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24327038" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003400000008/v1_201909271459/S2173580818301810/v1_201909271459/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003400000008/v1_201909271459/S2173580818301810/v1_201909271459/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580818301810?idApp=UINPBA00004N" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 October | 59 | 17 | 76 |
2024 September | 83 | 18 | 101 |
2024 August | 99 | 15 | 114 |
2024 July | 76 | 18 | 94 |
2024 June | 87 | 6 | 93 |
2024 May | 86 | 16 | 102 |
2024 April | 86 | 15 | 101 |
2024 March | 121 | 6 | 127 |
2024 February | 123 | 12 | 135 |
2024 January | 160 | 10 | 170 |
2023 December | 125 | 9 | 134 |
2023 November | 115 | 4 | 119 |
2023 October | 186 | 13 | 199 |
2023 September | 99 | 7 | 106 |
2023 August | 68 | 7 | 75 |
2023 July | 68 | 9 | 77 |
2023 June | 111 | 8 | 119 |
2023 May | 120 | 9 | 129 |
2023 April | 119 | 12 | 131 |
2023 March | 88 | 4 | 92 |
2023 February | 73 | 5 | 78 |
2023 January | 68 | 15 | 83 |
2022 December | 70 | 13 | 83 |
2022 November | 81 | 11 | 92 |
2022 October | 64 | 9 | 73 |
2022 September | 56 | 7 | 63 |
2022 August | 74 | 12 | 86 |
2022 July | 61 | 11 | 72 |
2022 June | 60 | 20 | 80 |
2022 May | 71 | 9 | 80 |
2022 April | 71 | 15 | 86 |
2022 March | 87 | 13 | 100 |
2022 February | 67 | 7 | 74 |
2022 January | 91 | 6 | 97 |
2021 December | 71 | 13 | 84 |
2021 November | 51 | 12 | 63 |
2021 October | 68 | 21 | 89 |
2021 September | 59 | 12 | 71 |
2021 August | 51 | 26 | 77 |
2021 July | 72 | 7 | 79 |
2021 June | 32 | 7 | 39 |
2021 May | 56 | 21 | 77 |
2021 April | 179 | 22 | 201 |
2021 March | 58 | 22 | 80 |
2021 February | 38 | 8 | 46 |
2021 January | 55 | 7 | 62 |
2020 December | 49 | 11 | 60 |
2020 November | 63 | 11 | 74 |
2020 October | 40 | 5 | 45 |
2020 September | 50 | 13 | 63 |
2020 August | 52 | 9 | 61 |
2020 July | 39 | 7 | 46 |
2020 June | 39 | 10 | 49 |
2020 May | 44 | 12 | 56 |
2020 April | 42 | 6 | 48 |
2020 March | 52 | 7 | 59 |
2020 February | 50 | 8 | 58 |
2020 January | 45 | 7 | 52 |
2019 December | 35 | 9 | 44 |
2019 November | 25 | 9 | 34 |
2019 October | 61 | 13 | 74 |
2019 September | 14 | 7 | 21 |
2019 August | 4 | 2 | 6 |
2019 July | 12 | 24 | 36 |
2019 June | 20 | 12 | 32 |
2019 May | 54 | 21 | 75 |
2019 April | 8 | 18 | 26 |
2019 March | 3 | 3 | 6 |
2019 February | 6 | 8 | 14 |
2019 January | 3 | 5 | 8 |
2018 December | 0 | 9 | 9 |
2018 November | 2 | 3 | 5 |