A Case of Wernicke's Encephalopathy Due to Pyloric Stenosis by Gastric Cancer and Thyroid Crisis Developed During Peripheral Intravenous Drip

Hiroshi Hirukawa, Kazuhiko Endo, Nobuyuki Goto, Hiroshi Ooya, Hiroshi Tomita, Kazuhiro Imai, Yoshihiko Kimura and Katsuyoshi Hatakeyama^*

Department of Surgery, Akita Kumiai General Hospital
^*First Department of Suegery, Niigata University School of Medicine

A 51 year-old woman a thyroid crisis was admitted and treated with antithyroid drugs, a β-adrenergic blocker, and peripheral intravenous drip of an electrolyte infusion without vitamins. Vertigo with fixation nystagmus appeared on day 12 after admission. On day 33, magnetic resonance imaging (MRI) showed a high intensity lesion around the crebral aqueduct and laboratory data showed a low vitamin B1 count, leading to a diagnosis of Wernicke's encephalopathy. Gastroscopy showed advanced gastric cancer with pyloric stenosis. Intravenous injection of vitamin B1 gradually improved vertigo, and was followed by distal gastrectomy. We inferred that the etiology of this encephalopathy was a high demand for vitamin B1 by hypermetabolism due to a thyroid crisis and intravenous glucose injection, and poor supply of this vitamin due to pyloric stenosis from gastric cancer. We concluded that vertigo with nystagmus is an important incipient symptom of Wernicke's encephalopathy and if it appears in the patient with anorexia and/or hypermetabolism, requires swift, suitable treatment. Wernicke's encephalopathy due to pyloric stenosis and thyroid crisis is extremely rare and we found no case reports in the world wide literature.

Key words
Wernicke's encephalopathy, pyloric stenosis, hyperthyroidism

Reprint requests
Hiroshi Hirukawa Department of Surgery, Akita Kumiai General Hospital 273-1 Nishihukuro, Iijima, Akita, 011-0911 JAPAN

Accepted
September 25, 2002

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