Wernicke encephalopathy: limitations in a laboratory and radiological diagnosis

BMJ Case Rep. 2023 Dec 11;16(12):e254786. doi: 10.1136/bcr-2023-254786.

Abstract

Wernicke encephalopathy is an emergent neurological disorder caused by vitamin B1 (thiamine) deficiency. Here, we present a case of Wernicke encephalopathy in a male patient in his 70s with normal serum thiamine levels and MRI findings on admission. He had a history of heavy alcohol consumption and a gradual decrease in food intake. On arrival at the hospital, his consciousness was impaired which persisted even after glucose replacement. Moreover, horizontal nystagmus and cerebellar ataxia were observed. Head CT scan and MRI revealed no abnormal findings. Further, his serum thiamine level was within the normal range. The patient was clinically diagnosed with Wernicke encephalopathy, and high-dose thiamine therapy was started. Then, his symptoms improved immediately. Thus, in case of clinical suspicion, treatment for Wernicke encephalopathy must be initiated promptly even in patients with normal serum thiamine levels.

Keywords: Alcohol-related disorders; Memory Disorders.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Beriberi* / complications
  • Humans
  • Korsakoff Syndrome* / etiology
  • Magnetic Resonance Imaging
  • Male
  • Thiamine
  • Thiamine Deficiency* / complications
  • Thiamine Deficiency* / diagnosis
  • Thiamine Deficiency* / drug therapy
  • Wernicke Encephalopathy* / diagnostic imaging
  • Wernicke Encephalopathy* / drug therapy

Substances

  • Thiamine