Metabolic Brain Disease

, Volume 6, Issue 4, pp 207–212

Thiamine deficiency and wernicke's encephalopathy in AIDS

  • Roger F. Butterworth
  • Christiane Gaudreau
  • Jean Vincelette
  • Anne-Marie Bourgault
  • Francois Lamothe
  • Anne-Marie Nutini
Original Contributions

Abstract

Several neuropathological reports in the last 5 years have described brain lesions characteristic of Wernicke's Encephalopathy in patients with AIDS. Using the erythrocyte transketolase activation assay, we now report biochemical evidence of thiamine deficiency in 9/39 (23%) of patients with AIDS or AIDS-related complex. In no cases was there history of alcohol abuse nor were there clinical signs of Wernicke's Encephalopathy. Thiamine deficiency in these patients most likely results from the cachexia and catabolic state characteristic of AIDS. In view of (i) the confirmed neuropathological evidence of Wernicke's Encephalopathy in AIDS patients, (ii) the significant thiamine deficiency in these patients and (iii) the difficulties of clinical diagnosis of Wernicke's Encephalopathy, it is recommended that dietary thiamine supplementation be initiated in all newly diagnosed cases of AIDS or AIDS-related complex.

Key words

AIDS AIDS-related complex thiamine deficiency Wernicke's Encephalopathy α-ketoglutarate dehydrogenase transketolase 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Butterworth R.F., Giguère J.-F., and Besnard A.-M. (1986). Activities of thiamine-dependent enzymes in two experimental models of thiamine-deficiency encephalopathy. 2. α-ketoglutarate dehydrogenaseNeurochem. Res. 11: 567–577.Google Scholar
  2. Butterworth R.F. (1989). Effects of thiamine deficiency on brain metabolism: implications for the pathogenesis of the Wernicke-Korsakoff Syndrome.Alcohol & Alcoholism 24: 271–279.Google Scholar
  3. Butterworth R.F., Gaudreau C., Vincelette J., Bourgault A.-M., Lamothe F., and Nutini A.-M. (1991). Thiamine deficiency in AIDS.Lancet 338: 1086.Google Scholar
  4. D'Amour M.L., Bruneau J., and Butterworth R.F. (1991). Abnormalities of peripheral nerve conduction in relation to thiamine status in alcoholic patients.Can. J. Neurol. Sci. 18: 126–128.Google Scholar
  5. Davtyan D.G., and Vinters H.V. (1987). Wernicke's Encephalopathy in AIDS patient treated with Zidovudine.Lancet 1: 919–920.Google Scholar
  6. Foresti V., Parisio E., Scolari N., Sparacio F., and Confalonieri F. (1986). Sindrome da immunodeficienza acquisita associata a tubercolosi disseminata ed a encefalopatia cronica di Wernicke.Recenti Progressi in Medicina 77: 350–352.Google Scholar
  7. Foresti V., and Confalonieri F. (1987). Wernicke's Encephalopathy in AIDS.Lancet (i), 1499.Google Scholar
  8. Harper C. (1979). Wernicke's Encephalopathy: a more common disease than realized.J. Neurol. Neurosurg. Psychiat. 42: 226–231.Google Scholar
  9. Heier M.S., and Fossa S.D. (1986). Wernicke-Korsakoff-like syndrome in patients with colorectal carcinoma treated with high-dose doxifluridine (5′-dFUrd).Acta Neurol. Scand. 73: 449–457.Google Scholar
  10. Hutchin K.C. (1987). Thiamine deficiency, Wernicke's Encephalopathy and AIDS.Lancet, 1200.Google Scholar
  11. Kwee I.L., and Nakada T. (1983). Wernicke's Encephalopathy induced by tolazamide.New Eng. J. Med. 309: 599–600.Google Scholar
  12. Lindboe C.F., and Loberg E.M. (1989). Wernicke's Encephalopathy in non-alcoholics. An autopsy study.J. Neurol. Sci. 90: 125–129.Google Scholar
  13. Mukherjee A.B., Ghazanfari A., Svoronos S., Staton R.C., Nakata T., and Kwee I.L. (1986). Transketolase abnormality in tolazamide-induced Wernicke's Encephalopathy.Neurol. 36: 1508–1510.Google Scholar
  14. Rosemberg S., Lopes M.B.S. and Tsanaclis A.M. (1986). Neuropathology of acquired immunodeficiency syndrome (AIDS). Analysis of 22 Brazilian cases.J. Neurol. Sci. 76: 187–198.Google Scholar
  15. Parry G.J. (1988). Peripheral neuropathies associated with human immunodeficiency virus infection.Ann. Neurol. 23: S49-S53.Google Scholar
  16. Schwenk J., Gosztonyl G., Theraulf P., Iglesias J. and Langer E. (1990). Wernicke's encephalopathy in two patients with acquired immunodeficiency syndrome.J. Neurol. 237: 445–447.Google Scholar
  17. Soffer D., Zirkin H., Alkan M. and Berginer V.M. (1989). Wernicke's encephalopathy in acquired immune deficiency syndrome (AIDS): a case report.Clin. Neuropathol. 8: 192–194.Google Scholar
  18. Torvik A., Linboe C.F. and Rodge S. (1982). Brain lesions in alcoholics. A neuropathological study with clinical correlations.J. Neurol. Sci. 56: 233–248.Google Scholar
  19. Victor M., Adams R.D., Collins G.H. (1989).The Wernicke Korsakoff Syndrome, F.A. Davis, Philadelphia.Google Scholar

Copyright information

© Plenum Publishing Corporation 1991

Authors and Affiliations

  • Roger F. Butterworth
    • 1
  • Christiane Gaudreau
    • 2
  • Jean Vincelette
    • 2
  • Anne-Marie Bourgault
    • 2
  • Francois Lamothe
    • 2
  • Anne-Marie Nutini
    • 3
  1. 1.Laboratory of Neurochemistry, André-Viallet Clinical Research CenterHôpital Saint-Luc (University of Montreal)MontrealCanada
  2. 2.Microbiology ServiceHôpital Saint-Luc (University of Montreal)MontrealCanada
  3. 3.Hematology ServiceHôpital Saint-Luc (University of Montreal)MontrealCanada

Personalised recommendations