Abstract
Thirty two cases of acute Wernicke's encephalopathy were observed in a period of 33 months, and prior to the mandatory thiamine enrichment of Australian bread-making flour in 1991. These cases were carefully assessed by multiple tests at specified intervals prior to, and following thiamine administration until discharge from hospital. Structured scoring of neurological signs and symptoms, CT scans, psychometry, nutritional measurements, and liver biopsies were performed. There was variation in the presentation and severity of clinical signs and symptoms and in response to treatment. All patients had alcohol-related liver disease, and the results indicated that fatty liver was important in presentation and in response to treatment with thiamine. Other forms of alcohol related brain damage were present in these patients, most of whom were in the 4th or 5th decade of life and had been drinking beer to excess for more than 20 years.
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References
Beutler, E. (1969a). Effect of flavin compounds on glutathione reductase activity.In vivo andin vitro studies.J. Clin. Invest. 48:1957.
Beutler, E. (1969b). Glutathione reductase: Stimulation in normal subjects by riboflavin supplementation.Science 165:613.
Bosnes R.W. and Taussky H.H. (1945). On the colorimetric determination of creatinine by the Jaffe reaction.J. Biol. Chem. 158:581.
Bowden, S. (1992). Is there more than one neuropsychological disorder commonly associated with alcohol dependence.Drug & Alcohol Rev. 11:299–304.
Breen, K. Buttigieg, R. Iossifidis, S. Lourensz, C, Wood, B. (1985). Jejunal uptake of thiamin hydrochloride in man:influence of alcoholism and alcohol.Amer. J. Clin. Nutr. 42:121–126.
Denson, K.W. and Bowers, E.F. (1961). The determination of ascorbic acid in white blood cells.Clin. Sci. 21:157.
Dreyfus, P.M. (1979). The effects of alcohol on the nervous system. In Gastineau, C.F., Darby, W.J., Turner, T.B. (eds.)Fermented food beverages in nutrition, New York:Academic Press., Ch. 22, p. 341.
Garrow, J.S. (1974).Energy balance and obesity in man. London: Elsevier North Holland.
Gold, J., Perdices, M., Lardner, K.et al. (1985). The Wernicke-Korsakoff Project - the final report. Sydney: School of Public Health and Tropical Medicine.
Harper, C. and Kril, J. (1990). The nature and progress of alcohol related brain injury. Proc of the 1990 Autumn School of Studies on Alcohol & Drugs, May 1990. Godding, R., Rankin D, & Whelan G (eds.). Melbourne: Dept. Comm. Med., St. Vincent's Hospital.
International Classification of Diseases (9th Revision) (1979). Clinical modification, Volume 1. Ann Arbor (Michigan): 1978 Commission on Professional and Hospital Activities.
Interdepartmental Committee on Nutrition for National Defence (1963).Manual for Nutrition Surveys. 2nd edn. Bethesda, Maryland: National Institutes of Health, p. 117, p. 136.
Karmen, A., Wroblewski, F., and La Due, J.S. (1955). Transaminase activity in human blood.J. Clin. Invest. 34:126.
Nie, N.H., Hadlai-Hull, C., Jenkins, J.G.et al. (1970).SPSS. Statistical Package for the Social Sciences. New York: McGraw - Hill.
Phillips, G.B., Victor, M., and Adams, R.D. (1952). A study of the nutritional defect in Wernicke's syndrome: Effect of purified diet, thiamine and other vitamins on clinical manifestations.J. Clin. Invest. 31:859–871.
Price, J. (1991). Neurological complications of alcohol usage.Drug & Alcohol Rev. 10:233–246.
Stanulovic, M., Miletic, D., and Stock, A. (1967). Die diagnostic des Vitamin B6-mangels auf grund der bestimmung von erythrocytarer 1-aspartat:2-oxoglutarat amino transpherase (glutamat-oxalacetate-transaminase) and ihrer stimulationin vitro mit pyridoxal-5′-phosphate.Clin. Chim. Acta 17:353.
Thomson, A.D., Baker, H., Leevy, C.M. (1970).35S-thiamin hydrochloride absorption in the malnourished alcoholic patient.J. Lab. Clin. Med. 76: 34–44.
Victor, M., and Adams, R.D. (1953). The effect of alcohol on the nervous system. In Merritt, H.H. & Hare, C. C. (eds.)Metabolic and toxic diseases of the nervous system. Res. Publ. Ass.: nerv. ment. Dis., Baltimore: The Williams & Wilkins Co., Vol.32, p.526.
Victor, M., Adams, R.D., Collins, G.H. (1971).The Wernicke-Korsakoff Syndrome. Oxford: Blackwell Scientific Publications.
Wechsler, D. (1958). The measurement and appraisal of adult intelligence. Baltimore, Maryland:Williams & Wilkins.
Wechsler D, Stone CP. (1945). Wechsler Memory Scale. New York, NY:The Psychological Corporation.
WHO. (1975). Manual of the international classification of diseases, injuries and cause of death. Geneva, Switzerland, Vol.1., p.156.
Wood, B. and Penington, D.G. (1973). Biochemical assessment of thiamine status in adult Australians.Int. J. Vit. Nutr. Res. 43:12–19.
Wood, B., Currie, J., Breen, K. (1986). Wernicke's encephalopathy in a metropolitan hospital: A prospective study of incidence, characteristics and outcome.Med. J. Aust. 1:12–16.
Wood, B., Goode, A., and Breen, K. (1988). Biochemical studies of riboflavin, pyridoxine and Vitamin C status in apparent health and in alcoholism.J. Food & Nutr. 45:9–12.
Wood, B., Nicholls, K.M., Breen, K.J. (1992). Nutritional status in alcoholism.J. Hum. Nutr. & Dietet. 5:275–285.
Wood, B., Breen, K., Walsh, K., and Santamaria, J. (1983). Wernicke's encephalopathy in alcoholism: Towards a better perspective by comparison with a defined population group.Aust. Alcohol/ Drug Rev. 2:74–80.
Wood, B., Gijsbers, A., Goode, A., Davis, S., Mulholland, J., Breen, K. (1980). Partial thiamin restriction in human volunteers.Am. J. Clin. Nutr. 33: 848–861.
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Wood, B., Currie, J. Presentation of acute Wernicke's encephalopathy and treatment with thiamine. Metab Brain Dis 10, 57–72 (1995). https://doi.org/10.1007/BF01991783
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DOI: https://doi.org/10.1007/BF01991783