Thiamine Deficiency in the Pathophysiology and Diagnosis of Wernicke-Korsakoff Syndrome: Case Report and Literature Review

Abstract

Thiamine deficiency is associated with life-threatening pathologies, as Wernicke syndrome (WS), Korsakoff syndrome (KS), Marchiafava-Bignami (MB) disease, and wet or dry beri-beri (BB). Among the etiological factors, the thiamine deficiency may be suspected in subjects at risk for malnutrition (decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption). Computed tomography (CT) but especially magnetic resonance imaging (MRI) is the best method to detect diencephalic and mesencephalic cytotoxic edematous lesions in patients with acute WS, with hyperintense on long-TR spin-echo MRI imaging and low-density signal abnormalities on CT scans. We report a case of WS in an 82-year-old woman with the history of cancer and eating disorder, who presented a neurological worsening during recovery, associated with low serum thiamine levels and the presence of symmetrical areas of hyperintense signal in the long-TR sequences of MRI. After parenteral thiamine supplementation, we observed a rapid improvement of ocular and language disorders occurred, with a low and incomplete improvement of peripheral neuropathy, supporting the WS diagnosis. Our case report presented the clinical picture of WS and KS and the diagnosis was confirmed by both the laboratory tests and the brain imaging techniques. The dosage of the vitamin was useful and accurate when performed before the beginning of the supplementation therapy. This case is important in bringing to light a clinical picture often observed in many medical recovery units.