Oncologie

, 10:560 | Cite as

Encéphalopathie de Gayet-Wernicke au décours d’une chimiothérapie émétisante

  • J. -C. Bourre
  • M. Laramas
  • M. Baconnier
  • P. -M. Ball
  • P. Pollak
  • P. Merloz
  • A. Krainik
Cas Clinique / Case Report
  • 31 Downloads

Résumé

Une patiente de 22 ans, prise en charge pour un sarcome d’Ewing claviculaire, a présenté au décours de l’intervention une confusion, une ophtalmoplégie et une ataxie. L’IRM, réalisée en urgence, a montré un hypersignal T2 de la substance grise péri-aqueducale, des colliculi, des faces internes des thalamus et des tubercules mamillaires très évocateurs d’une encéphalopathie de Gayet-Wernicke. Les dosages sanguins ont confirmé la carence en thiamine en rapport avec l’absence d’administration de vitaminothérapie préventive Iors de la chimiothérapie néo-adjuvante qui fut responsable de vomissements importants ayant imposé la mise en place d’une nutrition parentérale. Sous traitement substitutif, les symptômes ont totalement régressé en six jours. L’IRM de contrôle à six mois a montré la disparition complète des anomalies.

Mots clés

Chimiothérapie Alimentation parentérale Gayet-Wernicke Thiamine 

Wernicke’s encephalopathy following emetogenic chemotherapy

Abstract

A 22-year-old woman, referred for a clavicular Ewing’s sarcoma, was presenting with post-surgical confusion, ophthalmoplegia and ataxia. The MRI that was performed in emergency showed a hyper-intensity on T2-WI in the peri-aqueductal grey matter, colliculi, medial aspects of the thalami and the mamillary bodies, suggesting a Wernicke’s encephalopathy. Blood level of thiamine was decreased, likely to be due to the absence of preventive vitamin therapy during the neo-adjuvant chemotherapy which was responsible of vomiting and required initiation of parenteral nutrition. Symptoms relief was obtained within 6 days after administration of thiamine. The MRI, performed 6 months later, was normal.

Keywords

Chemotherapy Wernicke’s encephalopathy Parenteral nutrition Thiamine 

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Copyright information

© Springer Verlag France 2008

Authors and Affiliations

  • J. -C. Bourre
    • 1
  • M. Laramas
    • 2
  • M. Baconnier
    • 2
  • P. -M. Ball
    • 3
  • P. Pollak
    • 4
  • P. Merloz
    • 5
  • A. Krainik
    • 3
  1. 1.Clinique universitaire de médecine nucléaireCHU de GrenobleGrenoble cedex 09France
  2. 2.Pôle de cancérologieCHU de GrenobleGrenoble cedex 09France
  3. 3.Clinique universitaire de neuroradiologie et IRMCHU de GrenobleGrenoble cedex 09France
  4. 4.Département de neurologieCHU de GrenobleGrenoble cedex 09France
  5. 5.Service de chirurgie orthopédiqueCHU de GrenobleGrenoble cedex 09France

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