Simultaneous Scurvy and Wernicke's Encephalopathy in a Patient with an Ascorbate-Responsive Dyskinesia

Abstract

The eradication of malnutrition, including such micronutrient deficiencies as scurvy and beriberi, starting in developed nations and spreading throughout the world, was a major project of the 20th century. Much was accomplished both in illuminating the role of micronutrients and in improving their availability. 1 Yet much work remains to be done. Micronutrient deficiencies remain widely prevalent among developed Western countries. One study estimated that 20% of adults living in developed Western nations are deficient in vitamin C, and 10% in zinc. 2 Among special populations, the rates of deficiencies can be much higher. For example, Thornalley and colleagues found that over 70% of type 1 and type 2 diabetics have thiamine deficiencies. 3 Multiple micronutrient deficiencies may be the norm, as the risk factors for deficiency of one micronutrient are often the same for another. Furthermore, micronutrient deficiencies may affect not just mentation, but the course and outcome of medical and surgical care. Despite this, the clinical presentation of simultaneous deficiencies of vitamins B1 and C is rarely reported. The authors report the case of a patient who presented with both scurvy and Wernicke’s encephalopathy (WE).