Wernicke encephalopathy after gastrectomy due to thiamine deficiency

Case contributed by Yves Leonard Voss

Presentation

Ataxia, Vertigo, unstable gait. Low frequency upbeat nystagmus, Vertical gaze palsy. Mild amnestic syndrome (antegrade and retrograde). Disorientation to time and space. Sleeve-gastrectomy 2 months ago, resulting gastric stenosis. Gastroenterostomy 10 days ago.

Patient Data

Age: 30 years
Gender: Female

- T2 hyperintensity periaqueductal involving the quadrigeminal plate.

- T2 hyperintensity of the mamillary bodies.

No restricted diffusion. No contrast enhancement. No signs of infarction or inflammation.

Case Discussion

The patient presented in the neurologic ambulance with symptoms of ataxia, nystagmus and vertical gaze palsy. The patient was awake, NIHSS = 0. Disorientation to time and space. The additional neuropsychiologigal testing revealed no hallucinations or delusions, but mild amnestic syndrome with antegrade and retrograde deficits. Events of the last days were not correctly remembered.

The patient underwent bariatric surgery 2 months before presentation (sleeve-gastrectomy) which led to the neurological deficits in this case of thiamine deficiency induced Wernicke's encephalopathy.

Laboratory results showed Thiamine (Vitamin B1) deficiency (13,5 ng/ml, ref.: 20-100 ng/ml) and Folate deficiency (0,8 ng/ml, ref.: 4,6 - 18,7 ng/ml).

The MRI shows some typical signs of Wernickes encephalopathy in this nonalcoholic patient: FLAIR / T2 - hyperintensity periaqueductal involving the quadrigeminal plate and hyperintensityof the mamillary bodies.

The patient was treated with supplementary Vitamins and Folate and recovered within 2 weeks.

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Case information

rID: 56413
Case created: 30th Oct 2017
Last edited: 3rd Nov 2017
Inclusion in quiz mode: Included

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