Wernicke-Korsakoff Syndrome in Primary Peritoneal Cancer
A 76-year-old woman with primary peritoneal cancer and multiple lymph node metastases received 6 cycles of paclitaxel and carboplatin. After the 6 cycles of chemotherapy, partial response was achieved. Six months after her last chemotherapy cycle, she was admitted to the hospital because of sustained nausea and general weakness, which she had experienced for several months. Chest and abdominal-pelvic computed tomography scans showed that peritoneal metastasis and lymph node metastasis had progressed. Her serum CA-125 level was elevated (1,655 U/ml). She received continuous parenteral nutrition because of intractable nausea. Four days after admission, she developed disorientation and dizziness, which were followed by ataxia and diplopia. A neurologic examination indicated that she had ophthalmoplegia. Her laboratory findings were as follows: white blood cell count 6.59 × 109/l, hemoglobin 12.0 g/dl, hematocrit 35.8%, blood platelet count 230 × 109/l, serum total protein 6.1 g/dl, albumin 3.3 g/dl, glucose 111 mg/dl, aspartate aminotransferase 21 IU, alanine aminotransferase 14 IU, blood urea nitrogen 9.0 mg/dl, creatinine 0.15 mg/dl, Na 139 mm, K 4.6 mm, Cl 107 mm, and Ca++ 0.98 mg/dl. There was no evidence of systemic infection or brain metastasis. Magnetic resonance imaging (MRI) of the brain showed hyperintensity in the mammillary body, medial aspects of both halves of the thalamus, cerebral aqueduct, tectal plate, and dorsal medulla on T2 fluid-attenuated inversion recovery (FLAIR) images (fig. ). The patient's serum thiamine level was 2.0 μg/dl (normal range 2.0–7.2 μg/dl). These findings were consistent with Wernicke encephalopathy. Thiamine (100 mg) was urgently administered intravenously, and ataxia and diplopia improved 2 days after thiamine injection. The other symptoms improved gradually. Fifteen days after the thiamine injection, she had recovered from her symptoms but displayed anterograde amnesia and disorientation with respect to time. A follow-up MRI scan of the brain showed improvement in the abnormal lesion (fig. ).