{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:11:11Z","timestamp":1753891871573,"version":"3.41.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Wernicke\u2019s encephalopathy (WE), a neuropsychiatric emergency caused by thiamine deficiency, is increasingly recognized in nonalcoholic populations. We present a 64-year-old male with pyloric obstruction from gastric cancer (stage IIIA) who developed WE 20 days after gastrectomy. Prolonged thiamine-free total parenteral nutrition (TPN), delayed enteral intake, and cancer-related hypermetabolism jointly precipitated a thiamine deficiency. Undisclosed psychiatric comorbidity exacerbated diagnostic challenges and potential risk. Despite initial diagnostic challenges, timely neurological assessment and urgent brain MRI confirmed the diagnosis on the day of readmission. Immediate thiamine supplementation led to full neurological recovery. At six-month follow-up, the patient remained neurologically intact with structured dietary and psychological counseling, ensuring sustained psychiatric stability during adjuvant chemotherapy. This novel case of WE following radical gastrectomy, prolonged TPN, and in the context of gastric cancer with pyloric obstruction and undisclosed psychiatric comorbidity, underscores the necessity of multidisciplinary collaboration to optimize perioperative nutritional and psychosocial management in high-risk oncological surgical populations.<\/jats:p>","DOI":"10.3389\/fonc.2025.1595004","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T04:10:33Z","timestamp":1750651833000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Wernicke\u2019s encephalopathy following radical gastrectomy and prolonged parenteral nutrition: a case report of pyloric obstruction and undisclosed psychiatric comorbidity"],"prefix":"10.3389","volume":"15","author":[{"given":"Hanchen","family":"Ma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuaichen","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linchuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruizhao","family":"Zong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xueyu","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingjie","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunmiao","family":"Pan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiankang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangyong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198504183121606","article-title":"Wernicke\u2019s encephalopathy","volume":"312","author":"Reuler","year":"1985","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2019.02.018","article-title":"Wernicke encephalopathy-clinical pearls","volume":"94","author":"Sinha","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-020-00989-3","article-title":"Comprehensive review of wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings","volume":"38","author":"Ota","year":"2020","journal-title":"Jpn J Radiol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03153.x","article-title":"EFNS guidelines for diagnosis, therapy and prevention of wernicke encephalopathy","volume":"17","author":"Galvin","year":"2010","journal-title":"Eur J Neurol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1136\/jnnp.62.1.51","article-title":"Operational criteria for the classification of chronic alcoholics: identification of Wernicke\u2019s encephalopathy","volume":"62","author":"Caine","year":"1997","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70104-7","article-title":"Wernicke\u2019s encephalopathy: new clinical settings and recent advances in diagnosis and management","volume":"6","author":"Sechi","year":"2007","journal-title":"Lancet Neurol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.psym.2015.10.001","article-title":"Nonalcoholic thiamine-related encephalopathy (wernicke-korsakoff syndrome) among inpatients with cancer: a series of 18 cases","volume":"57","author":"Isenberg-Grzeda","year":"2016","journal-title":"Psychosomatics"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951514001163","article-title":"Palliative treatment of thiamine-related encephalopathy (wernicke\u2019s encephalopathy) in cancer: a case series and review of the literature","volume":"13","author":"Isenberg-Grzeda","year":"2015","journal-title":"Palliat Support Care"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2023.07.021","article-title":"Hospital outcomes in medical patients with alcohol-related and non-alcohol-related wernicke encephalopathy","volume":"99","author":"Rasiah","year":"2024","journal-title":"Mayo Clin Proc"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.alcalc.a044913","article-title":"Effects of thiamine deficiency on brain metabolism: implications for the pathogenesis of the wernicke-korsakoff syndrome","volume":"24","author":"Butterworth","year":"1989","journal-title":"Alcohol Alcohol Oxf Oxfs"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuint.2010.08.022","article-title":"Up-regulation of caveolin-1 and blood-brain barrier breakdown are attenuated by N-acetylcysteine in thiamine deficiency","volume":"57","author":"Beauchesne","year":"2010","journal-title":"Neurochem Int"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1136\/pmj-2022-141972","article-title":"Thiamine deficiency: a commonly unrecognised but easily treatable condition","volume":"99","author":"Schostak","year":"2023","journal-title":"Postgrad Med J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/1477-7819-11-144","article-title":"Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy","volume":"11","author":"Meng","year":"2013","journal-title":"World J Surg Oncol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/nyas.13031","article-title":"Vitamin B1 (thiamine) and dementia","volume":"1367","author":"Gibson","year":"2016","journal-title":"Ann N Y Acad Sci"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: Clinical Nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin Nutr Edinb Scotl"},{"key":"B16","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1177\/0004563220939604","article-title":"Don\u2019t seek, don\u2019t find: The diagnostic challenge of Wernicke\u2019s encephalopathy","volume":"58","author":"Kohnke","year":"2021","journal-title":"Ann Clin Biochem"},{"key":"B17","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1007\/s11910-017-0747-9","article-title":"The spectrum of vestibular and ocular motor abnormalities in thiamine deficiency","volume":"17","author":"Kattah","year":"2017","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/jon.13143","article-title":"The role of MRI in the prognosis of Wernicke\u2019s encephalopathy","volume":"33","author":"Kitaguchi","year":"2023","journal-title":"J Neuroimag"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-012-9203-4","article-title":"Neuroimaging of wernicke\u2019s encephalopathy and korsakoff\u2019s syndrome","volume":"22","author":"Jung","year":"2012","journal-title":"Neuropsychol Rev"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.013","article-title":"Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy","volume":"73","author":"Rose","year":"2020","journal-title":"J Hepatol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1756284820924194","DOI":"10.1177\/1756284820924194","article-title":"Chemotherapy-associated liver injury in colorectal cancer","volume":"13","author":"Gangi","year":"2020","journal-title":"Ther Adv Gastroenterol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2019.0303","article-title":"Acute acquired metabolic encephalopathy based on diffusion MRI","volume":"22","author":"Jeon","year":"2021","journal-title":"Korean J Radiol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.06.019","article-title":"Anti-Ma encephalitis masquerading as Wernicke encephalopathy","volume":"79","author":"Meng","year":"2020","journal-title":"J Clin Neurosci Off J Neurosurg Soc Australas"},{"key":"B24","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1080\/13554794.2022.2106143","article-title":"A case of new cognitive changes in a patient with seronegative paraneoplastic limbic encephalitis: encephalitis relapse or Wernicke\u2019s encephalopathy","volume":"28","author":"Zhang","year":"2022","journal-title":"Neurocase"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agl054","article-title":"Multiple cerebral metastases mimicking Wernicke\u2019s encephalopathy in a chronic alcoholic","volume":"41","author":"Yaldizli","year":"2006","journal-title":"Alcohol Alcohol Oxf Oxfs"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-309598","article-title":"Wernicke-Korsakoff syndrome not related to alcohol use: a systematic review","volume":"86","author":"Scalzo","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","first-page":"CD004033","DOI":"10.1002\/14651858.CD004033.pub3","article-title":"Thiamine for prevention and treatment of wernicke-korsakoff syndrome in people who abuse alcohol","volume":"2013","author":"Day","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S166437","article-title":"Disclosure of cancer diagnosis in China: the incidence, patients\u2019 situation, and different preferences between patients and their family members and related influence factors","volume":"10","author":"Liu","year":"2018","journal-title":"Cancer Manag Res"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.03.031","article-title":"ESPEN practical guideline: Clinical nutrition in surgery","volume":"40","author":"Weimann","year":"2021","journal-title":"Clin Nutr Edinb Scotl"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00208","article-title":"Resilience in cancer patients","volume":"10","author":"Seiler","year":"2019","journal-title":"Front Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"107074","DOI":"10.1016\/j.ejso.2023.107074","article-title":"Malnutrition in cancer patients: Causes, consequences and treatment options","volume":"50","author":"Arends","year":"2024","journal-title":"Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2712","DOI":"10.3390\/nu15122712","article-title":"Psychosocial factors and the need for multidisciplinary support in nutrition counselling for cancer chemotherapy patients","volume":"15","author":"Koshimoto","year":"2023","journal-title":"Nutrients"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-010-0103-6","article-title":"Oral cancer chemotherapy: the critical interplay between patient education and patient safety","volume":"12","author":"Halfdanarson","year":"2010","journal-title":"Curr Oncol Rep"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1595004\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T04:10:34Z","timestamp":1750651834000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1595004\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":33,"alternative-id":["10.3389\/fonc.2025.1595004"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1595004","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2025,6,23]]},"article-number":"1595004"}}