Fatal Wernicke's Encephalopathy with Cardiovascular Involvement in a Young Psychiatric Patient

Wernicke Encephalopathy Presenting With Hearing Loss and Vision Loss in a Nonalcoholic Patient

Wernicke encephalopathy is an acute neuropsychiatry syndrome resulting from thiamine deficiency associated with significant morbidity and mortality. We reported a case of a 25-year-old woman with a history of abdomen pain, nausea, vomiting, weight loss, and sore throat who presented with acute neurological symptoms, including binocular diplopia, hearing loss, vision loss, and difficulty ambulating. Examination revealed bilateral vision loss with perception only to light, ophthalmoplegia, hearing loss, gait ataxia, and areflexia. Laboratory work detected multiple vitamin deficiencies. Magnetic resonance imaging (MRI) of the brain showed increased T2 signal in the bilateral medial thalami and periaqueductal areas. Empirical treatment with intravenous thiamine resulted in rapid clinical and radiological resolution.

Diagnosis and treatment of Wernicke's encephalopathy: A systematic literature review

BACKGROUND

Wernicke's encephalopathy (WE) is a serious neurological disorder that is underdiagnosed. Despite limited clinical guidelines, the standard use of intravenous (IV) thiamine is underutilized and remains an area of research deserving much attention.

OBJECTIVES

We conducted a systematic review using Medline, Embase, and CENTRAL databases to identify and summarize the literature on IV thiamine treatment in WE. Human studies with WE patients who received ≥100 mg of thiamine IV met inclusion criteria. Randomized controlled trials, cross-sectional studies, and case reports were included.

RESULTS

A total of 27 studies were included: 20 case reports, five retrospective studies, one prospective study and one randomized control trial. Of the case reports, 11 (55%) cases were female, and the average age of all cases was 45 years (SD = 15). The other seven studies included 688 patients; the average age was 52 years (SD = 9), and 266 (38.7%) were female. Among the case reports, neurological and clinical findings were used to diagnose WE in 16 (80%) cases. MRI was utilized to diagnose 15 (75%) cases. 500 mg IV thiamine TID was reported in 12 case reports (60%). 18 (90%) of case reports had partial or complete resolution of symptoms following IV thiamine.

CONCLUSION

IV thiamine can alleviate neurological symptoms, cognitive dysfunction, and brain imaging lesions associated with WE. We found key limitations in the evidence for IV thiamine and diagnostic standards for WE. Future targeted research should establish clear diagnostic and treatment guidelines for WE to prevent this serious condition from being underdiagnosed or undertreated.