Wernicke\u27s Encephalopathy after Gastrectomy and Adjuvant Chemotherapy Using S-1 for Gastric cancer :Report of a Case

Wernicke\u27s encephalopathy is a disease usually related to chronic alcoholism. We reported a case of Wernicke\u27sencephalopathy after distal gastrectomy and chemotherapy using S-1 despite of no history of alcoholism.A 58-year-old woman underwent distal gastrectomy for gastric carcinoma in February, 2005. Shereceived adjuvant chemotherapy using S-1, since histological examination of the removal specimens showedregional lymph nodes metastasis. After this therapy, she rapidly developed diplopia, ataxia and disturbanceof consciousness. Although brain CT and the routine laboratory data showed no abnormal changes, brainMRI showed a symmetrical high-intensity area in the third ventricle and periaqueductal regions;this wascharacteristic of Wernicke\u27s encephalopathy. She was immediately treated with thiamine, and recoveredconsciousness within a few hours. S-1 based on 5-fluorouracil( 5-FU) which reduced the thiamine levels inthe patient, may have worsened the thiamine deficiency caused by distal gastorectomy. Therefore, cliniciansshould pay attention to suspicious symptoms of thiamine deficiency in patients who have undergone gastrectomy,particularly those who receive adjuvant chemotherapy with S-1 or 5-FU