Wernicke's Encephalopathy in a Patient with Peptic Ulcer Disease

Akinori Uruha,Shiro Matsubara,Tomoji Katoh,Toshio Shimizu,Yasushi Yamasaki

doi:10.1155/2011/156104

Abstract

We report a 74-year-old man with Wernicke's encephalopathy (WE) whose only prior illness was peptic ulcer disease. Upper gastrointestinal endoscopy demonstrated gastric ulcer scars accompanied by marked deformity, without pathologic evidence of malignancy. WE due to peptic ulcer disease in previous reports was substantially associated with thiamine deficiency due to recurrent vomiting or surgical procedures. In our case, however, there was no history of vomiting or gastrointestinal surgery. Besides, we thoroughly ruled out other known clinical settings related to WE. There is the possibility that peptic ulcer disease itself provoked thiamine deficiency due to malabsorption.

Highlights

Wernicke’s encephalopathy (WE) is an acute neuropsychiatric syndrome characterized by nystagmus and ophthalmoplegia, ataxia of gait, and mental confusion
WE due to peptic ulcer disease in previous reports was substantially associated with thiamine deficiency due to recurrent vomiting or surgical procedures; the mechanisms of thiamine deficiency after surgical procedures include the occurrence of recurrent vomiting, poor compliance with an adequate dietary intake, and the reduced area of the gastrointestinal mucosa for absorbing thiamine [1, 2]
The present patient was diagnosed as having WE based on the low serum thiamine concentration, response of neurological signs to parenteral thiamine administration, and typical brain magnetic resonance imaging (MRI) findings

Summary

Introduction

Wernicke’s encephalopathy (WE) is an acute neuropsychiatric syndrome characterized by nystagmus and ophthalmoplegia, ataxia of gait, and mental confusion. We describe a case of nonalcoholic WE in peptic ulcer disease. WE due to peptic ulcer disease in previous reports was substantially associated with thiamine deficiency due to recurrent vomiting or surgical procedures; the mechanisms of thiamine deficiency after surgical procedures include the occurrence of recurrent vomiting, poor compliance with an adequate dietary intake, and the reduced area of the gastrointestinal mucosa for absorbing thiamine [1, 2].

Results

Conclusion