A case report: Non-alcoholic Wernicke encephalopathy associated with polyneuropathy

ASMBS literature review & clinical guidelines on prevention, diagnosis, and treatment of Wernicke's encephalopathy and Wernicke-Korsakoff syndrome

The American Society for Metabolic and Bariatric Surgery (ASMBS) Wernicke's Task Force issues the following guidelines to enhance the quality of care in patients undergoing bariatric surgery and for other populations at risk of thiamine deficiency and Wernicke's encephalopathy (WE). This paper examines the current literature regarding the prevention, diagnosis, and treatment of WE. These guidelines intend to provide an objective summary of current peer-reviewed literature and provide clinical practice recommendations based on this literature and expert opinions. The goal is to enhance awareness and reduce the incidence of WE and the Wernicke-Korsakoff syndrome (WKS). This statement is not intended to establish a local, regional, or national standard of care and may be revised in the future as additional evidence becomes available.

Wernicke Encephalopathy Related to Hyperemesis Gravidarum: A Retrospective Study of 12 Cases

Objective: Wernicke encephalopathy (WE) related to hyperemesis gravidarum (HG) is a devastating neuropsychiatric syndrome that remains frequently undiagnosed in pregnant women. Although many cases have been published, more studies are required to establish guidelines for the early detection and treatment of this condition. Material and Methods: We conducted a retrospective study to analyze the available data concerning 12 cases of WE complicating HG in the Mother and Child Hospital's Obstetric Intensive Care Unit, belonging to Mohamed VI University Hospital of Marrakesh. Results: Twelve out of 76 HG admitted cases developed WE. Pregnant WE patients became depleted after 11 weeks of vomiting at median gestational weeks of 16.2. They had a severe weight loss of more than 5% of their body and had all presented prodromal signs of WE before the actual onset of the clinical triad. WE diagnosis was clinically made based on Caine's operational criteria as they allow early identification of the disease. A good tool that could also aid diagnosis is an encephalic MRI; however, it should not delay treatment with prompt administration of high doses of thiamin of > 500 mg/day. Chronic sequelae in this study occurred in 45.5% and death in one case. Conclusion: In HG, thiamin rapidly depletes which can lead to WE with adverse outcomes for the mother and fetus. Therefore, physicians must be vigilant in detecting early signs of WE to promptly provide a high dose of thiamin with targeted multimodal therapies as this could be lifesaving.

A Case Report of Wernicke’s Encephalopathy Disguised As Limbic Encephalitis: A Clinical Puzzle

Wernicke's encephalopathy (WE) is the presence of neurological symptoms in the central nervous system caused by thiamine (Vitamin B1) deficiency. It is an acute clinical condition characterized by confusion, ataxia, and ophthalmoplegia triad. WE is most commonly observed in chronic alcohol users, while it can also present in non-alcoholics. We present a 33-year-old man with alcohol-induced WE who presented with altered mental status and fever. His initial diagnosis was skewed towards bacterial meningitis and limbic encephalitis, but MRI findings were consistent with WE. The patient responded promptly to intravenous (IV) thiamine infusion, and his mental status changed significantly. Repeat EEG in 15 days shows complete recovery with normal brain wave activity. Untreated WE is a significant cause of permanent neurological morbidity and mortality, easily preventable. High suspicion of WE should always be entertained, especially when patients have a known history of alcohol use. Early initiation of IV thiamine could prevent the consequences. Hence, it is essential to raise awareness of WE to take measures without delay and reduce mortality and morbidity with an improved prognosis.

A Case of Wernicke’s Encephalopathy Due to Idiopathic Gastroparesis: A Rare Cause of Encephalopathy in a Young Woman

Wernicke’s encephalopathy (WE) is a rare, life-threatening neurological disease due to thiamine deficiency. It is most commonly associated with chronic alcoholism but is also associated with disorders of malabsorption and malnutrition. We present a case of a young female with idiopathic gastroparesis who developed Wernicke’s encephalopathy due to poor oral intake and malnutrition as a result of gastroparesis. This case exemplifies that Wernicke’s encephalopathy should be on the differential in patients who present with encephalopathy with a history of gastroparesis.

Wernicke Encephalopathy Due to Hyperemesis Gravidarum in Pregnancy: A Case Report

Wernicke's encephalopathy (WE) is a life-threatening acute or sub-acute neurological emergency characterized by ataxia, confusion, nystagmus, and ophthalmoparesis caused by thiamine deficiency. It was first described in 1881 by Carl Wernicke with alcohol being the most common cause. We present a rare case of a 35-year-old pregnant female who presented to our emergency department with a history of vomiting and loose motions for two weeks. She later developed fever, confusion, slurred speech and blurring of vision. Magnetic resonance imaging (MRI) of the brain revealed typical lesions of WE. She was immediately treated with thiamine and her symptoms improved in a few days.