Thursday, September 11, 2014

Not enough vitamin B1 can cause brain damage

Toxins, other metabolic disorders also can cause encephalopathy, Loyola neurologists report

MAYWOOD, Ill. (Sept. 11, 2014) – A deficiency of a single vitamin, B1 (thiamine), can cause a potentially fatal brain disorder called Wernicke encephalopathy.

Symptoms can include confusion, hallucinations, coma, loss of muscle coordination and vision problems such as double vision and involuntary eye movements. Untreated, the condition can lead to irreversible brain damage and death, according to neurologists at Loyola University Medical Center.

In the developed world, Wernicke encephalopathy typically occurs in people who have disorders such as alcoholism and anorexia that lead to malnourishment.

Wernicke encephalopathy is an example of the wide range of brain diseases, called encephalopathies, that are caused by metabolic disorders and toxic substances, according to a report by Loyola neurologists Matthew McCoyd, MD, Sean Ruland, DO, and José Biller, MD, in the journal Scientific American Medicine.

Acute encephalopathy has a rapid onset of between hours and days. It is commonly due to toxic and metabolic factors.

“Toxic and metabolic encephalopathies may range in severity from the acute confusional state to frank coma,” McCoyd, Ruland and Biller write. “As permanent injury may occur, an organized approach is needed to make an accurate and rapid diagnosis."

The hallmark of toxic and metabolic encephalopathies is altered sensorium. This can range from mild attention impairment, such as difficulty spelling a word backwards, to coma.

Toxic encephalopathy can be caused by illegal drugs, environmental toxins and reactions to prescription drugs.

Thiamine deficiency is among the nutritional deficiencies that can cause brain diseases such as Wernicke encephalopathy. The condition likely is underdiagnosed. Although clinical studies find a rate of 0.13 percent or less, autopsy studies show a prevalence as high as 2.8 percent.

“Particularly in those who suffer from alcoholism or AIDS, the diagnosis is missed on clinical examination in 75 to 80 percent of cases,” the Loyola neurologists write.
Untreated, Wernicke encephalopathy can lead to Korsakoff syndrome (KS), characterized by profound memory loss and inability to form memories; patients often can’t remember events within the past 30 minutes. Other KS symptoms can include apathy, anxiety and confabulation (fabricating imaginary experiences to compensate for memory loss).

About 80 percent of Wernicke encephalopathy patients develop KS, and once this occurs, only about 20 percent of patients recover.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.