1. Non-alcoholic Wernicke encephalopathy: great masquerader
- Author
-
Chukwudumebi Okafor, Sarthak Soin, Lavanya Lanka, and Manojna Nimmagadda
- Subjects
Male ,medicine.medical_specialty ,Vomiting ,Cholecystitis, Acute ,Gastroenterology ,03 medical and health sciences ,Dysarthria ,0302 clinical medicine ,Internal medicine ,Vertigo ,Weight Loss ,medicine ,Humans ,Wernicke Encephalopathy ,030212 general & internal medicine ,Obesity ,Diplopia ,medicine.diagnostic_test ,biology ,business.industry ,food and beverages ,Brain ,Thiamine Deficiency ,Magnetic resonance imaging ,Nausea ,General Medicine ,Middle Aged ,medicine.disease ,biology.organism_classification ,Magnetic Resonance Imaging ,Diabetes Mellitus, Type 2 ,Lactic acidosis ,Cholecystitis ,Thiamine ,Learning from Errors ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Thiamine is an important coenzyme, which is essential for metabolism and maintaining cellular osmotic gradient. Thiamine deficiency can cause focal lactic acidosis, alteration of the blood–brain barrier and the production of free radicals through cell death by necrosis and apoptosis. Wernicke encephalopathy (WE) is a clinical diagnosis. Cytotoxic and vasogenic oedema are the most typical neuroimaging findings of WE, presenting as bilateral symmetrical hyperintense signals on T2-weighted MR images. MRI is not necessary for the diagnosis of WE, but it can be helpful in ruling out alternative diagnosis. We present the case of an 61-year-old man with the history of class II obesity presenting with diplopia, dysarthria and vertigo, confirmed to be non-alcoholic WE. We aim to highlight the occurrence of WE in patients with large bowel resection though. Delay in diagnosis, particularly in obese individuals due to lack of suspicion, can lead to grim prognosis.
- Published
- 2018