Wernicke’s Encephalopathy Not So Uncommon: A Case Report

INTRODUCTION

Chronic alcoholic patients present with multiple disorders. Central nervous system involvement is common in patients with chronic alcohol use.¹ Most of them present with hepatic encephalopathy. Patients with alcohol use also have a thiamine deficiency because of chronic malnutrition. A potential life-threatening complication of thiamine deficiency is Wernicke’s encephalopathy.² Wernicke encephalopathy is characterized by a triad of symptoms: ophthalmoplegia (eye signs), cerebellar dysfunction, ataxia, and altered mental state (confusion).³ Most patients with Wernicke’s encephalopathy are alcoholics.

CASE PRESENTATION

A 34-year-old male was admitted to the hospital with a history of an episode of generalized clonic–tonic convulsion followed by unresponsive and unconscious with downward gaze. His Glasgow coma scale (GCS) was 3/15. He was suspected to have encephalopathy and was evaluated further. He was hemodynamically stable without any inotropic support. He was electively intubated for airway protection in view of his low GCS. All his blood tests were performed, suspecting hepatic encephalopathy, but it was absolutely normal. A cerebrospinal fluid study was done, which was also a normal limit. Magnetic resonance imaging of the brain is suggestive of cytotoxic injury with diffuse cerebellar edema (Fig. 1). Echocardiography was within limits. All the other laboratory parameters were within normal limits (Table 1). We ruled out all other causes of acute encephalopathy. We started him on intravenous thiamine, suspecting vitamin deficiency causing encephalopathy. He responded very well to intravenous thiamine and recovered within 4 days of hospitalization.

DISCUSSION

Chronic alcoholic patients present with multiple neurological disorders. Cerebrospinal fluid involvement is common in patients with chronic alcohol use.¹ Most of them present with hepatic encephalopathy. Patients with alcohol use also have a thiamine deficiency because of chronic malnutrition.¹ A potential life-threatening complication of thiamine deficiency is Wernicke’s encephalopathy. Wernicke encephalopathy is characterized by a triad of symptoms: ophthalmoplegia (eye signs), cerebellar dysfunction, ataxia, and altered mental state (confusion).² Most patients with Wernicke’s encephalopathy are alcoholics. Our patient responded very well to intravenous thiamine and we also ruled out hepatic and viral causes of encephalopathy in this patient.

CONCLUSION

Chronic alcoholic patients can present with multiple neurological illnesses. Most of them have hepatic involvement, and the cause of their encephalopathy is due to hepatic etiology. But vitamin deficiency is also a very important cause of encephalopathy, particularly in alcoholic patients due to nutritional deficiency. We must consider thiamine deficiency as a cause of encephalopathy while treating encephalopathy patients, especially those who are alcoholics, because thiamine deficiency is one of the common causes of encephalopathy.

ORCID

Ankush Balasaheb Kolhe https://orcid.org/0000-0002-8698-2548

REFERENCES

1. Harper C. Thiamine (vitamin B1) deficiency and associated brain damage is still common throughout the world and prevention is simple and safe! Eur J Neurol 2006;13(10):1078–1082. DOI: 10.1111/j.1468-1331.2006.01530.x.

2. Naidoo DP, Bramdev A, Cooper K. Wernicke’s encephalopathy and alcohol-related disease. Postgrad Med J 1991;67(793):978–981. DOI: 10.1136/pgmj.67.793.978.

3. Chung SP, Kim SW, Yoo IS, et al. Magnetic resonance imaging as a diagnostic adjunct to Wernicke encephalopathy in the ED. Am J Emerg Med 2003;21(6):497–502. DOI: 10.1016/s0735-6757(03)00094-9.