Restrictive diet in a patient with irritable bowel syndrome leading to Wernicke encephalopathy

Qiang Wang,Ilena C George,Zeinab Charmchi

doi:10.1186/s12876-021-01758-w

Abstract

BackgroundWe present a case of a woman with a past medical history of irritable bowel syndrome (IBS) and anxiety, who presents with ophthalmoplegia, ataxia and memory loss, characteristic of Wernicke encephalopathy.Case presentationA 64-year-old woman presented with double vision, unsteady gait and memory loss. These symptoms began after 3 months on an unfortified restricted diet, which she initiated to alleviate IBS symptoms. Magnetic resonance imaging of the brain demonstrated hyperintense T2-weighted signal in the dorsomedial aspect of bilateral thalami, periaqueductal grey matter and around the third ventricle. The patient’s visual symptoms improved significantly after thiamine supplementation, although her memory deficits persisted.ConclusionAlthough WE is often associated with chronic alcohol abuse, this case demonstrates the importance of recognizing WE in any patient with a restricted diet and subsequent timely initiation of thiamine.

Highlights

We present a case of a woman with a past medical history of irritable bowel syndrome (IBS) and anxiety, who presents with ophthalmoplegia, ataxia and memory loss, characteristic of Wernicke encephalopathy.Case presentation: A 64-year-old woman presented with double vision, unsteady gait and memory loss
Wernicke encephalopathy (WE) is often associated with chronic alcohol abuse, this case demonstrates the importance of recognizing WE in any patient with a restricted diet and subsequent timely initiation of thiamine
Wernicke encephalopathy (WE) is a neurological emergency resulting from thiamine deficiency, which impairs thiamine-dependent glucose and nucleic acid metabolism and in turn causes apoptosis due to N‐methyl‐d‐aspartate (NMDA) toxicity, especially in the thalamus and the mammillary bodies [1]

Summary

Conclusion

WE is often associated with chronic alcohol abuse, this case demonstrates the importance of recognizing WE in any patient with a restricted diet and subsequent timely initiation of thiamine.

Background

Findings

Discussion and conclusions