Wernicke's Encephalopathy.

Smit Patel,Lawrence Hudson,Karan Topiwala

doi:10.7759/cureus.3187

Smit Patel, Lawrence Hudson + Show 1 more

Open Access

https://doi.org/10.7759/cureus.3187

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Journal: Cureus	Publication Date: Aug 22, 2018
Citations: 6	License type: cc-by

Affiliation: Hartford Hospital

Abstract

Wernicke’s encephalopathy (WE) is a neurologic emergency that requires immediate attention to prevent permanent neurological morbidity and mortality. It presents with confusion, ophthalmoplegia and gait ataxia which together comprise its classic triad. Thiamine deficiency related to alcohol abuse remains the primary culprit; non-alcoholic WE, however, can have an atypical clinical presentation and is often missed. Thus, although the diagnosis of WE remains primarily clinical, neuroimaging plays an important role, especially in the diagnosis of non-alcoholic WE. Here, we present a case of non-alcoholic WE with an atypical clinical presentation but typical magnetic resonance imaging (MRI) findings in a woman with a history of non-bariatric gastrointestinal surgery. Thiamine replacement therapy rapidly reversed her neurologic symptoms and MRI findings.

Highlights

In 1881, Carl Wernicke described acute encephalopathy as characterized by mental confusion, ophthalmoplegia, nystagmus and gait ataxia
Wernicke encephalopathy (WE) is an acute neurological emergency resulting from a deficiency of thiamine, the most common cause of which is alcohol abuse; prolonged starvation, hyperemesis gravidarum and gastrointestinal surgery can lead to Wernicke’s encephalopathy (WE) [2]
Up to 80% of cases get missed during a routine clinical examination, and autopsy-based studies indicate that almost 82% of the patients with WE present with delirium [10]

Summary

Introduction

In 1881, Carl Wernicke described acute encephalopathy as characterized by mental confusion, ophthalmoplegia, nystagmus and gait ataxia. She was started on high-dose IV thiamine (500 mg three times daily for two days followed by 250 mg daily for five days followed by oral treatment with 100 mg daily) along with other B-complex vitamins and magnesium. Repeat brain MRI one week later showed significantly reduced hyperintensities in the thalamus and the dorsal midbrain region Her hospital course was complicated by Pseudomonas and Klebsiella pneumonia requiring intubation, along with sepsis and progressive multiple organ failure. Patient was treated with high dose intravenous thiamine with repeat MRI brain, one week later showing a significant improvement (E, F, G and H)

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Disclosures