<div>Gayet Wernicke encephalopathy after cephalic pancreaticoduodenectomy</div><div>H. Mirali, N. Aichouni, H.Berkhli, S.Nasri, I.Kamaoui, B.Serji ,
I.Skiker</div><div>Corresponding author:<i>mirali.houda@gmail.com</i></div><div>Department of radiology, university hospital Mohamed VI</div><div>Faculty of medicine and pharmacy, university Mohamed first</div><div>Introduction:</div><div>Gayet- Wernicke encephalopathy is a neurological disorder resulting from
deficiency of thiamine, commonly related to a chronic abuse of alcohol,
we report a case of 53 years old male, with adenocarcinoma of the
ampulla of vater, that start presenting 2 weeks after cephalic
pancreaticoduodenectomy a change in mental status, confusion,
disorientation and became unresponsive. The diagnosis is Clinical and
confirmation made by magnetic resonance imaging (MRI).</div><div>Case report:</div><div>A 53 years old male, with no medical history, consults for cholestatic
jaundice, physical examination was without abnormalities, biological
tests revealed hyperbilirubinemia. Imaging and upper endoscopy
demonstrated an ampullary cancer. The patient benefited from a cephalic
pancreaticoduodenectomy, and installed gastroparesis s and vomiting. two
weeks after surgery, the patient start presenting a change in mental
status, confusion, disorientation and became unresponsive. MRI revealed
bilateral symmetrical abnormal hyperintensities in both thalami(Figure
1, 2). The patient was treated with high dose parental thiamine with
intravenous dose followed by oral thiamine.</div><div>Discussion:</div><div>Nonalcoholic Gayet Wernicke encephalopathy is a rare entity usually
associated to malnourished patients, hyperemesis gravidarum, and
postoperative patients, it is caused by thiamine deficiency, and the
diagnosis is based on a triad of ophthalmoplegia, ataxia and mental
disturbance. MRI imaging is very specific using FLAIR sequence [1],
showing hyperintensities in the thalamus, mammillary bodies and
periaqueductal area. The treatment is based on high dose thiamine with
parenteral administration (100mg a day for 2 weeks) followed by oral
administration (100 to 300 mg a day) for 3 to 12 months [2].</div><div>References:</div><div>[1]: A case report of nonalcoholic gayet-wernicke encephalopathy :
don’t miss thiamine</div><div>Kompal
Jain, DA, DNB,* Jasveer Singh,
MD, Anant
Jain,
and Tanvi
Khera,</div><div>[2]: Wernicke’s encephalopathy after cephalic
pancreaticoduodenectomy Francisco Gabriel Onieva-González1 , Gerardo
Blanco-Fernández2 , Luis Munuera-Romero1 , Jesús Márquez-Rojas1 , Manuel
Robles-Marcos3 and Guillermo Solórzano-Peck2</div>