All issues > Volume 44(11); 2001

Case Report

J Korean Pediatr Soc. 2001;44(11):1320-1325. Published online November 15, 2001.

A Case of Wernicke's Encephalopathy which Occurred During Chemotherapy in a Child with Acute Myeloblastic Leukemia

Sang-Nam SN Bae¹, Bu-Jin BJ Kim¹, Seong-Shik SS Park¹, Sang-Ook SO Nam¹, Young-Tak YT Lim¹, Hak-Jin HJ Kim²

¹Department of Pediatrics, College of Medicine, Pusan National University, Pusan, Korea
²Department of Radiology, College of Medicine, Pusan National University, Pusan, Korea

Correspondence Young-Tak YT Lim ,Email: lymyt@hyowon.pusan.ac.kr

Abstract

Wernicke,s encephalopathy(WE), a neurological disorder caused by thiamine deficiency, is characterized by the triad of ocular symptoms, ataxia, and mental confusion. More than 90% of the cases are observed in chronic alcoholics. Other conditions less frequently associated with WE are anorexia nervosa, prolonged parenteral nutrition, hemodialysis, uremia, hyperemesis gravidarum, gastroplasty for morbid obesity, and acquired immunodeficiency syndrome(AIDS). One of the rare diseases associated with WE is tumors of the lymphoid-hemopoietic systems. We experienced a case of WE in a 15-year-old girl presented with bilateral horizontal nystagmus, bilateral abducens nerve palsy, mental confusion, disorientation, and ataxia after suffering anorexia, persistent vomiting, and watery diarrhea for 30 days following chemotherapy for acute myeloblastic leukemia. The serum thiamine level was 13.4 ng/mL(normal : 18.4-53.1). Brain MR T2-weighted image revealed a high signal intensity lesions bilaterally at the medial thalamus, pons, tectum, mammilary body, lateral wall of third ventricle, and putamen. Bilateral abducens nerve palsy, ataxia, and mental confusion improved dramatically following thiamine 100 mg/day replacement for 4 days. After two monthly follow-up, she was left with a residual fine bilateral horizontal nystagmus. We confirmed this case by clinical symptoms, brain MR findings, low thiamine level, and clinical response following thiamine replacement, and report with a brief review of the literature.

Keywords :Wernicke's encephalopathy, Acute myeloblastic leukemia