NTCT-11WERNICKE ENCEPHALOPATHY IN CANCER PATIENTS: A LITERATURE REVIEW

OBJECTIVE: To assess the frequency of Wernicke Encephalopathy (WE) in cancer patients and to determine if prophylaxis with thiamine prevents neurologic complications. BACKGROUND: Wernicke's Encephalopathy (WE) is a known neurologic complication in cancer patients due to suspected etiologies such as chronic malnutrition, chemotherapy-associated vomiting, and thiamine consumption by rapidly growing tumors. MRI brain is considered the most valuable method to confirm the diagnosis. Currently amongst the cancer population there is no standardized approach to obtain thiamine levels, brain MRI, thiamine dose and duration, and when to initiate prophylaxis. METHODS: We utilized the search engine PubMed to review a total of 78 cases reported between 1990-2015. Patients with history of alcoholism were excluded from our review. RESULTS: The most common types of cancer associated with WE were gastrointestinal tract (35.6%) followed by hematopoietic cancers (34.6%), gynecological cancers (9%), CNS cancers and head and neck gynecological cancers (6.4% each) and others (7.6%). WE was also frequently seen in patients treated with; antimetabolites (29.48%), followed by alkylating and anthracyclines agents (24.3% each), and Mitotic inhibitors (6.4%). Of the 78 cases reviewed 61.5% were females, with mean age of 44. Brain MRIs were obtained in 78% of patients, of those 93% revealed positive radiological findings. 76.9% of patients received thiamine, despite only 24% that had serum thiamine levels checked. 70.5% showed partial or total recovery after thiamine supplementation. The thiamine doses were variable and not frequently reported. Total parental nutrition was reported in 46.1% of patients. CONCLUSION: WE needs to be considered in all cancer patients, especially GI and hematopoietic cancers. Work up should consist of thiamine levels and MRI brain. Thiamine supplementation should be reinforced amongst patients receiving TPN. We recommend standardized WE prophylaxis in cancer patients in order to prevent neurologic complications.