1
|
Turrini I, Guidetti C, Contaldo I, Pulitanò S, Rigante D, Veredice C. Wernicke Encephalopathy Caused by Avoidance-Restrictive Food Intake Disorder in a Child: A Case-Based Review. Diseases 2024; 12:112. [PMID: 38920544 PMCID: PMC11202895 DOI: 10.3390/diseases12060112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Wernicke encephalopathy (WE) is an acute and potentially fatal neuropsychiatric disorder resulting from thiamine deficiency: its etiology and clinical presentation can be heterogeneous and arduously recognized, especially in children and adolescents. CASE PRESENTATION An 8-year-old girl arrived to the emergency room with ataxic gait, nystagmus, and mental confusion after a 10-day history of repeated severe vomiting; her recent clinical history was characterized by restricted nutrition due to a choking phobia, which caused substantial weight loss. Brain magnetic resonance imaging revealed a bilaterally increased T2 signal in the medial areas of the thalami and cerebral periaqueductal region. Diagnosis of WE based on clinical and neuroradiological findings was established and confirmed after labwork showing low serum thiamine. Following psychiatric evaluation, the patient was also diagnosed with avoidance-restrictive food intake disorder (ARFID), which required starting cognitive behavioral therapy and introducing aripiprazole. The patient displayed improvement of the radiological findings after one month and complete resolution of her neurological symptoms and signs. CONCLUSIONS Eating disorders like ARFID might forerun acute signs of WE; this possibility should be considered even in pediatric patients, especially when atypical neurological pictures or feeding issues come out.
Collapse
Affiliation(s)
- Ida Turrini
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
| | - Clotilde Guidetti
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
| | - Ilaria Contaldo
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
| | - Silvia Pulitanò
- Pediatric Intensive Care Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Donato Rigante
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Veredice
- Pediatric Neurology Unit, Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.T.); (C.V.)
| |
Collapse
|
2
|
Thompson JP, Rittenberry JC, Lawton AW, Kirchner KR. Wernicke's Encephalopathy From Gastrointestinal Disease After Remote Roux-en-Y. J Neuroophthalmol 2024; 44:e147-e148. [PMID: 36729906 DOI: 10.1097/wno.0000000000001776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- John P Thompson
- Louisiana State University at New Orleans (JPT, JCR, KRK), New Orleans, Louisiana; and Ochsner Medical Center Ophthalmology (AL), New Orleans, Louisiana
| | | | | | | |
Collapse
|
3
|
Micronutrient Deficiencies Presenting with Optic Disc Swelling Associated with or without Intracranial Hypertension: A Systematic Review. Nutrients 2022; 14:nu14153068. [PMID: 35893919 PMCID: PMC9331791 DOI: 10.3390/nu14153068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a neurological disorder characterised by optic disc swelling secondary to raised intracranial pressure (ICP) of unknown cause. Obesity is the most established and prevalent risk factor in developed countries. As obesogenic diets are high in calories and nutrient-poor, there may be associated nutritional deficiencies that contribute to the clinical presentation of IIH. Yet none, aside from iron deficiency, are currently included in the inclusion or exclusion criteria for the diagnosis of IIH. Our primary aim was to determine which micronutrient deficiencies, aside from iron deficiency, could present with optic disc swelling associated with or without intracranial hypertension that could potentially meet current IIH diagnostic criteria. To this end, we conducted a systematic search of articles published between 1 January 1980 and 18 December 2020 reporting cases of optic disc swelling associated with micronutrient deficiencies. In total, 65 cases met the eligibility criteria from initial searches: all were case reports and case series with a high risk of bias. Our findings suggest that patients with IIH or unexplained optic disc swelling ought to be screened, investigated, and treated for associated micronutrient deficiencies in vitamin A, B1 and B12; and weight loss interventions in IIH patients ought to promote better nutrition in addition to overall calorie restriction.
Collapse
|
4
|
Rakotoambinina B, Hiffler L, Gomes F. Pediatric thiamine deficiency disorders in high-income countries between 2000 and 2020: a clinical reappraisal. Ann N Y Acad Sci 2021; 1498:57-76. [PMID: 34309858 PMCID: PMC9290709 DOI: 10.1111/nyas.14669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
Often thought to be a nutritional issue limited to low- and middle-income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high-income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine-deficient mothers living in disadvantaged socioeconomic conditions are thought to be rare. This study aims to assess PTD in HICs in the 21st century. Literature searches were conducted to identify case reports of PTD observed in HICs and published between 2000 and 2020. The analyzed variables were age, country, underlying conditions, clinical manifestations of PTD, and response to thiamine supplementation. One hundred and ten articles were identified, totaling 389 PTD cases that were classified into four age groups: neonates, infants, children, and adolescents. Eleven categories of PTD-predisposing factors were identified, including genetic causes, lifestyle (diabetes, obesity, and excessive consumption of sweetened beverages), eating disorders, cancer, gastrointestinal disorders/surgeries, critical illness, and artificial nutrition. TD-associated hyperlactatemia and Wernicke encephalopathy were the most frequent clinical manifestations. The circumstances surrounding PTD in HICs differ from classic PTD observed in LMICs and this study delineates its mutiple predisposing factors. Further studies are required to estimate its magnitude. Awareness is of utmost importance in clinical practice.
Collapse
Affiliation(s)
- Benjamin Rakotoambinina
- Cellular Nutrition Research GroupLagny sur MarneFrance
- LRI Isotopic Medicine Physiology LabUniversity of AntananarivoAntananarivoMadagascar
| | | | - Filomena Gomes
- The New York Academy of SciencesNew YorkNew York
- NOVA Medical SchoolUniversidade NOVA de LisboaLisboaPortugal
| |
Collapse
|
5
|
Ye L, Xu Z, Deng J, Yang J. Classical Triad and Periventricular Lesions Do Not Necessarily Indicate Wernicke's Encephalopathy: A Case Report and Review of the Literature. Front Neurol 2020; 11:451. [PMID: 32587564 PMCID: PMC7297919 DOI: 10.3389/fneur.2020.00451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
The classical triad—ophthalmoplegia, cerebellar dysfunction, and altered mental state—in addition to bilateral symmetrical periventricular lesions are actually common to see, and clinicians tend to associate that with Wernicke's encephalopathy (WE). The diagnosis is strengthened with a likely deficiency of thiamine. We herein describe a malnourished patient with clinical triad and hyperintensities in the circumventricular regions, and she turned out to have neuromyelitis optica spectrum disorder (NMOSD) after many twists and turns. Despite totally different pathogenic mechanisms, NMOSD can mimic WE, sometimes even exhibiting radiological features similar to that of WE, thereby complicating the diagnosis. Our case highlights how similar these two diseases could be and the importance of differential diagnosis in clinical practice, which are so far rarely reported. Some clinical and radiological differences of these two diseases are summarized to help establish a prompt diagnosis.
Collapse
Affiliation(s)
- Lisha Ye
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhouwei Xu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiangshan Deng
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiajun Yang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
6
|
Oh SY, Lee J, Kang JJ, Park YH, Kim KW, Lee JM, Kim JS, Dieterich M. Altered Resting-State Functional Connectivity in Wernicke's Encephalopathy With Vestibular Impairment. Front Neurol 2019; 10:1035. [PMID: 31611841 PMCID: PMC6776602 DOI: 10.3389/fneur.2019.01035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: To reveal the neural basis of Wernicke's encephalopathy (WE) with impaired vestibulo-ocular reflex (VOR), we evaluated resting-state functional connectivity (rs-fc) in the vestibular processing brain regions. Methods: Rs-fc between the vestibular regions and the rest of the brain were compared with neurotological features including the head-impulse tests (vHIT) and caloric responses in patients with WE (n = 5, mean age 53.4 ± 10 years) and healthy controls (n = 20, mean age 55.0 ± 9.2 years). Rs-fc analyses employed a region of interest (ROI)-based approach using regions selected a priori that participate in vestibular processing including the cerebellar vermis, insula, parietal operculum, and calcarine cortex. Results: The main neurologic findings for patients with WE were mental changes; gait ataxia; spontaneous and gaze-evoked nystagmus (GEN); and bilaterally positive HIT for the horizontal canals. Video HIT documented bilateral horizontal canal dysfunction with decreased gain and corrective saccades. Caloric irrigation and rotation chair testing revealed prominent bilateral horizontal canal paresis. Patients with WE also had decreased spatial memory, which substantially recovered after treatments. Functional connections at the predefined seed regions, including the insular cortex and parietal operculum, were attenuated in the WE group compared to healthy controls. Conclusions: WE is related to impaired VOR and visuospatial dysfunction, and fMRI documented changes in the rs-fc of multisensory vestibular processing regions including the insula, parietal operculum, and superior temporal gyrus, which participate in integration of vestibular perception.
Collapse
Affiliation(s)
- Sun-Young Oh
- Department of Neurology, School of Medicine, Chonbuk National University Hospital, Jeonju, South Korea.,Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonju, South Korea
| | - Juhyung Lee
- Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonju, South Korea.,Department of Preventive Medicine, School of Medicine, Chonbuk National University Hospital, Jeonju, South Korea
| | - Jin-Ju Kang
- Department of Neurology, School of Medicine, Chonbuk National University Hospital, Jeonju, South Korea.,Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonju, South Korea
| | - Yeong-Hun Park
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Ko Woon Kim
- Department of Neurology, School of Medicine, Chonbuk National University Hospital, Jeonju, South Korea.,Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonju, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.,German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| |
Collapse
|
7
|
Howard R, Chataway J, Edwards M, Heales S, Lachmann R, Leff A, Murphy E. Toxic, Metabolic and Physical Insults to the Nervous System and Inherited Disorders of Metabolism. Neurology 2016. [DOI: 10.1002/9781118486160.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
8
|
Deeb A, Qadry S, Al Memari A, Shatila A, Reddy J, Elfatih A, Al Sayouf H. Thyrotoxicosis With Development of Wernicke Encephalopathy in an Adolescent. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15880.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
9
|
Hwang MW, Moon SH. A Case of Acute Incomitant Esotropia Associated with Wernike's Encephalopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.1.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Moon Won Hwang
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- Therapeutics Center for Ocular Neovascular Disease, Busan, Korea
| | - Sung Hyuk Moon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- Therapeutics Center for Ocular Neovascular Disease, Busan, Korea
| |
Collapse
|
10
|
Cefalo MG, De Ioris MA, Cacchione A, Longo D, Staccioli S, Arcioni F, Bernardi B, Mastronuzzi A. Wernicke encephalopathy in pediatric neuro-oncology: presentation of 2 cases and review of literature. J Child Neurol 2014; 29:NP181-5. [PMID: 24293308 DOI: 10.1177/0883073813510355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wernicke encephalopathy represents a well-known entity characterized by a set of cognitive and neurologic alterations. Wernicke encephalopathy is rare and under-recognized in childhood and may be fatal. Few cases have been documented in pediatric oncology. We report on 2 Wernicke encephalopathy cases that occurred in children having a brain tumor. The diagnosis of Wernicke encephalopathy was suggested by clinical manifestations associated with the typical radiologic findings and a laboratory evidence of thiamine deficiency. No large series have been published to support the evidence that pediatric malignancies represent a demonstrated factor of increased risk to develop a Wernicke encephalopathy. Moreover, the diagnosis may be even more difficult in brain tumors, considering the overlapping symptoms and the risk of encephalopathy related to both the disease and the treatment. Wernicke encephalopathy should be considered in all children with cancer presenting a neurologic deterioration, mainly in brain tumors. An early diagnosis is imperative for a prompt therapy that might prevent or minimize the irreversible brain damage related to this condition.
Collapse
Affiliation(s)
| | | | | | - Daniela Longo
- Ospedale Pediatrico Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Susanna Staccioli
- Ospedale Pediatrico Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Francesco Arcioni
- University of Perugia, S.M. Misericordia University Hospital, Perugia, Rome, Italy
| | - Bruno Bernardi
- Ospedale Pediatrico Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | |
Collapse
|
11
|
Desai SD, Shah DS. Atypical Wernicke's syndrome sans encephalopathy with acute bilateral vision loss due to post-chiasmatic optic tract edema. Ann Indian Acad Neurol 2014; 17:103-5. [PMID: 24753673 PMCID: PMC3992745 DOI: 10.4103/0972-2327.128567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 03/26/2013] [Accepted: 05/09/2013] [Indexed: 11/25/2022] Open
Abstract
A middle aged male presented with acute bilateral vision loss, 4 weeks after undergoing gastric bypass surgery for gastric carcinoma. He had normal sensorium, fundoscopy, normal pupillary reaction to light, but had mild opthalmoparesis and nystagmus with ataxia. Magnetic resonance imaging of the brain revealed post-chiasmatic optic tract edema along with other classical features of Wernicke's syndrome. Thiamine supplementation leads to complete resolution of clinical as well as imaging findings. In appropriate clinical settings, a high index of suspicion and early treatment are essential for managing Wernicke's syndrome even in patients with atypical clinical and imaging presentation.
Collapse
Affiliation(s)
- Soaham Dilip Desai
- Department of Neuromedicine, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Diva Sidharth Shah
- Department of Radiology, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW The purpose of this study is to review commonly encountered adverse ocular effects of illicit drug use. RECENT FINDINGS Drug and alcohol abuse can produce a variety of ocular and neuro-ophthalmic side effects. Novel, so-called 'designer', drugs of abuse can lead to unusual ocular disorders. Legal substances, when used in manners for which they have not been prescribed, can also have devastating ophthalmic consequences. SUMMARY In this review, we will systematically evaluate each part of the visual pathways and discuss how individual drugs may affect them.
Collapse
|
13
|
Thiamine-deficient optic neuropathy associated with Wernicke's encephalopathy in patients with chronic diarrhea. J Formos Med Assoc 2013; 112:165-70. [DOI: 10.1016/j.jfma.2012.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 07/30/2009] [Accepted: 09/19/2009] [Indexed: 11/20/2022] Open
|
14
|
Irreversible Optic Neuropathy in Wernicke Encephalopathy and Leber Hereditary Optic Neuropathy. J Neuroophthalmol 2010; 30:49-53. [DOI: 10.1097/wno.0b013e3181ce80c6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
15
|
Abstract
Optimal functioning of the central and peripheral nervous system is dependent on a constant supply of appropriate nutrients. The first section of this review discusses neurologic manifestations related to deficiency of key nutrients such as vitamin B(12), folate, copper, vitamin E, thiamine, and others. The second section addresses neurologic complications related to bariatric surgery. The third sections includes neurologic presentations caused by nutrient deficiencies in the setting of alcoholism. The concluding section addresses neurologic deficiency diseases that have a geographic predilection.
Collapse
Affiliation(s)
- Neeraj Kumar
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| |
Collapse
|
16
|
Zuccoli G, Siddiqui N, Bailey A, Bartoletti SC. Neuroimaging findings in pediatric Wernicke encephalopathy: a review. Neuroradiology 2009; 52:523-9. [DOI: 10.1007/s00234-009-0604-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
|
17
|
Nixon PF. Glutamate Export at the Choroid Plexus in Health, Thiamin Deficiency, and Ethanol Intoxication: Review and Hypothesis. Alcohol Clin Exp Res 2008; 32:1339-49. [DOI: 10.1111/j.1530-0277.2008.00727.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
18
|
Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007; 6:442-55. [PMID: 17434099 DOI: 10.1016/s1474-4422(07)70104-7] [Citation(s) in RCA: 694] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality. According to autopsy-based studies, the disorder is still greatly underdiagnosed in both adults and children. In this review, we provide an update on the factors and clinical settings that predispose to Wernicke's encephalopathy, and discuss the most recent insights into epidemiology, pathophysiology, genetics, diagnosis, and treatment. To facilitate the diagnosis, we classify the common and rare symptoms at presentation and the late-stage symptoms. We emphasise the optimum dose of parenteral thiamine required for prophylaxis and treatment of Wernicke's encephalopathy and prevention of Korsakoff's syndrome associated with alcohol misuse. A systematic approach helps to ensure that patients receive a prompt diagnosis and adequate treatment.
Collapse
|
19
|
A case report of Wernicke's encephalopathy in a pediatric patient with anorexia nervosa--restricting type. J Adolesc Health 2007; 40:376-83. [PMID: 17367738 DOI: 10.1016/j.jadohealth.2006.11.140] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 11/03/2006] [Accepted: 11/14/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe a case of Wernicke's encephalopathy in a 15-year-old female patient with anorexia nervosa--restricting type. METHOD The patient and family were interviewed. Literature relevant to the case was reviewed prior to diagnosis. RESULTS The patient reported a 30-kg weight loss over a 6-month period, following a strict diet deplete in thiamine without vitamin supplementation. The patient reported a carbohydrate binge for 5 days prior to admission. Her clinical presentation, confusion, ataxia, nystagmus, and magnetic resonance imaging demonstrating bilateral subthalamic hyperdensities were consistent with Wernicke's encephalopathy. Nutritional stabilization and parenteral thiamine replacement resulted in rapid improvement of her ataxia and nystagmus and contributed to her recovery. CONCLUSIONS Wernicke's encephalopathy should be considered in patients with anorexia nervosa. Thiamine therapy could be considered in cases of anorexia nervosa with significant confusion.
Collapse
|