Postoperative encephalopathy: thiamin deficiency as a possible aetiology.

We report the case of a patient who experienced a postoperative Wernicke en cephalopathy 8 days after a left hepatectomy performed for metastasis relat ed to a rectal cancer. During the six months before surgery the patient los t 10 kg of weight (15%). Moreover, in the postoperative period the patient received exclusively 5% dextrose solution intravenously. On the 8(th) posto perative day, an alteration of consciousness, a vertical nystagmus and an a taxia led to consider the diagnosis of thiamine deficiency that was then es tablished by the decrease in the transcetolase activity of the red blood ce lls. Vitamin B1 supply improved the clinical status rapidely and completely . This observation allows to review aetiologies and clinical forms of thiam ine shortage. In addition, it stresses the detection of exposed patients an d the prevention methods. (C) 2001 Editions scientifiques et medicales Else vier SAS.