Abstract
Wernicke encephalopathy (WE) is the most common neurological complication of thiamine deficiency in patients who have a background of chronic alcohol use disorder. WE is characterized by acute onset of confusion, gait ataxia, and oculomotor dysfunction. Prompt treatment with parenteral thiamine leads to improvement. Untreated WE has mortality rates of up to 20% and many cases progress to the more chronic Korsakoff syndrome. Cases of untreated WE in which symptoms last beyond the acute phase and become chronic are rarely found in the literature. Here, we present a case of a 64-year-old female having a background of chronic alcohol use disorder presenting with symptoms of gait ataxia, recurrent falls, and decreased concentration. These symptoms had progressed over a period of nine months. The patient was seen by her family physician and several specialists undergoing many diagnostic studies with inconclusive results. Ultimately, with a high index of suspicion for thiamine deficiency, she was admitted for IV thiamine treatment. Upon follow-up in the clinic, the patient reported improvement in her balance and concentration further confirming the initial suspicion of WE with thiamine deficiency as the cause of her symptoms. This case corroborates the existence of WE as a chronic phenomenon in addition to the more commonly reported acute WE. Furthermore, this case highlights the importance of recognizing WE as a potential cause of chronic neurological symptoms in people with alcohol-related disorders and the role of IV thiamine in treatment.
Highlights
The principal neurological consequence of thiamine deficiency in the setting of chronic alcohol use disorder is Wernicke-Korsakoff syndrome [1,2]
Our patient showed some improvement with parenteral thiamine therapy but did not achieve complete resolution of symptoms. This partial recovery shows that the prognosis of Wernicke encephalopathy (WE) depends on timely diagnosis and early treatment with thiamine. This case illustrates that the chronic sequela of untreated WE is still not completely understood in some patients and further study into this phenomenon is the need of the hour
The key to avoiding chronic neurological symptoms in these patients is recognizing and treating WE early on. This case provides us with a valuable lesson that IV thiamine is beneficial in acute WE and in patients presenting with chronic symptoms
Summary
The principal neurological consequence of thiamine deficiency in the setting of chronic alcohol use disorder is Wernicke-Korsakoff syndrome [1,2]. These symptoms were ongoing for the past several months. The patient continued to receive oral thiamine; despite initial rapid improvement in her symptoms, her progress plateaued She continued to have some residual neurological deficits, including problems with balance and mild confusion much less pronounced than before
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