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World J Gastroenterol. Jul 14, 2006; 12(26): 4224-4227
Published online Jul 14, 2006. doi: 10.3748/wjg.v12.i26.4224
Pancreatic encephalopathy and Wernicke encephalopathy in association with acute pancreatitis: A clinical study
Guo-Hui Sun, Yun-Sheng Yang, Qing-Sen Liu, Liu-Fang Cheng, Xu-Sheng Huang
Guo-Hui Sun, Yun-Sheng Yang, Qing-Sen Liu, Liu-Fang Cheng, Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
Xu-Sheng Huang, Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Guo-Hui Sun, Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China. sungh301xhk@yahoo.com.cn
Telephone: +86-10-66937078 Fax: +86-10-68159496
Received: February 26, 2006
Revised: March 10, 2006
Accepted: March 20, 2006
Published online: July 14, 2006
Abstract

AIM: To investigate clinical characteristics and therapy of pancreatic encephalopathy (PE) and Wernicke encephalopathy (WE).

METHODS: In a retrospective study of 596 patients with acute pancreatitis (AP), patients with PE were compared to those with WE in regards to history, clinical manifestation, diagnosis, treatment and outcome.

RESULTS: There were 93 patients with severe acute pancreatitis (SAP). Encephalopathies were discovered in 10 patients (1.7%). Six patients with PE all developed in SAP (6.5%), and three of them died (3% of SAP, 50% of PE). Four patients with WE developed in AP (0.7%), and two of them died (0.3% of AP, 50% of WE). Two patients with WE were treated with parenteral thiamine and survived. Global confusions were seen in all patients with encephalopathy. Ocular abnormalities were found. Conjugate gaze palsies were seen in 1 of 6 (16.7%) patients with PE. Of 4 patients with WE, one (25%) had conjugate gaze palsies, two (50%) had horizontal nystagmus, three (75%) had diplopia, and one (25%) had myosis. Ataxia was not seen in all patients. None of patients with WE presented with the classic clinical triad. CSF examinations for 2 patients with WE showed lightly-increased proteins and glucose. CT and MRI of the brain had no evidence of characteristic abnormalities.

CONCLUSION: PE occurs in early or reiteration stage of SAP, and WE in restoration stage of SAP/AP. Ocular abnormalities are the hallmarks of WE, and horizontal nystagmus is common. It is difficult to diagnose earlier an encephalopathy as PE or WE, as well as differentiate one from the other. Long fasting, hyperemesis and total parenteral nutrition (TPN) without thiamine are main causes of thiamine deficiency in the course of pancreatitis.

Keywords: Pancreatic encephalopathy; Wernicke encephalopathy; Acute pancreatitis; Thiamine; Total parenteral nutrition