Abstract
Background. Wernicke's encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency. It is mainly related to alcohol abuse but it can be associated with other conditions such as gastrointestinal disorders. This vitamin deficiency can also present with cardiovascular symptoms, called “wet beriberi.” Association with folate deficit worsens the clinical picture. Subject. A 70-year-old man with gastric phytobezoar presented with gait instability, dyspnoea, chest pain associated with right heart failure and pericarditis, and folate deficiency. Furosemide was administered and cardiac symptoms improved but he soon developed vertiginous syndrome, nystagmus, diplopia, dysmetria, and sensitive and motor deficit in all four limbs with areflexia. Results. A cerebral magnetic resonance imaging (MRI) showed typical findings of WE. He was immediately treated with thiamine. Neurological symptoms improved in a few days and abnormal signals disappeared in a follow-up MRI two weeks later. Conclusion. Patients with malabsorption due to gastrointestinal disorders have an increased risk of thiamine deficiency, and folate deficiency can make this vitamin malabsorption worse. An established deficiency mainly shows neurological symptoms, WE, or rarely cardiovascular symptoms, wet beriberi. Early vitamin treatment in symptomatic patients improves prognosis. We recommend administration of prophylactic multivitamins supplements in patients at risk as routine clinical practice.
Highlights
Wernicke’s encephalopathy (WE) is a neurological disorder caused by thiamine deficiency
We present a case of WE caused by vitamin malabsorption of gastrointestinal origin preceded by wet beriberi and folate deficiency
We report the case of a 70-year-old male patient with a history of hypertension, hyperlipidaemia, peptic ulcer with duodenal stenosis and duodenitis, chronic gastritis, and gastric phytobezoar, “intraluminal mass caused by the accumulation of nondigestible vegetable fibers.”
Summary
Wernicke’s encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency. It is mainly related to alcohol abuse but it can be associated with other conditions such as gastrointestinal disorders. This vitamin deficiency can present with cardiovascular symptoms, called “wet beriberi.”. Association with folate deficit worsens the clinical picture. A cerebral magnetic resonance imaging (MRI) showed typical findings of WE. Patients with malabsorption due to gastrointestinal disorders have an increased risk of thiamine deficiency, and folate deficiency can make this vitamin malabsorption worse. An established deficiency mainly shows neurological symptoms, WE, or rarely cardiovascular symptoms, wet beriberi. We recommend administration of prophylactic multivitamins supplements in patients at risk as routine clinical practice
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