Search

Background: Thiamin is an essential vitamin that is involved in every organ system in the body. Thiamin deficiency can present as beriberi or Wernicke's encephalopathy. We seek to educate practitioners in developed countries to include beriberi on the differential diagnosis when a patient with alcohol use disorder, poor diet and/or disordered eating presents with ascending paralysis without albuminocytologic dissociation. Case : In this case report, a 20-year-old female with no past medical history presented with three weeks of ascending paralysis. At presentation, she could not grasp objects, walk, or rise from a seated position. She reported consuming excessive alcohol and an otherwise limited diet due to picky eating. The patient was ultimately diagnosed with acute inflammatory demyelinating polyneuropathy secondary to dry beriberi from severe protein-calorie malnutrition and alcohol use disorder. She received an aggressive thiamin replacement regimen as well as physical and occupational therapy. She was discharged to home 24 days after her initial presentation. Discussion : This patient case offers a unique presentation of ascending paralysis without albuminocytologic dissociation due to severe dry beriberi from a diet of unenriched carbohydrates and excessive alcohol in an otherwise young, healthy adult in the United States. Our goal is that in reviewing the unusual details of this case, providers will be better equipped for the timely diagnosis and treatment of similar cases in the future.

Thiamine (vitamin B1) deficiency is a common condition in alcohol abusers, which can lead to damage of both the peripheral and the central nervous systems. Here we describe the case of an alcoholic patient who presented with acute onset of ataxia, severe weakness of the four limbs, and hypoesthesia and dysesthesia of the distal portion of the upper and lower extremities. The clinical picture also included mental confusion and amnesia. A diagnosis of Wernicke-Korsakoff syndrome was made based on clinical symptoms and brain RMI findings. Electromyography and electroneurography revealed signs of subacute axonal sensory-motor polyneuropathy that were compatible with a rare acute presentation of beriberi. Patient immediately received parenteral thiamine administration, which resulted in rapid clinical amelioration of ataxia and confusion and also in a significant improvement of motor and sensory deficits. The association between Wernicke-Korsakoff syndrome and acute axonal polyneuropathy is a very rare condition that could make less recognizable the clinical picture of a thiamine deficiency. However, the diagnosis of thiamine deficiency should be suspected in every alcoholic patient presenting with acute onset symptoms of central and/or peripheral nervous system involvement. This because the immediate replacement treatment can be life-saving and reverse the clinical symptoms., (Copyright © 2017 Elsevier B.V. All rights reserved.)

"Shoshin beriberi", which is a fulminant form of cardiovascular beriberi accompanied by hemodynamic deterioration with high cardiac output and decreased systemic blood pressure, caused by thiamine deficiency due to alcoholic abuse or malnutrition, is often difficult to address because of its rarity and non-specific symptoms. We here present a patient with a history of alcoholic abuse who had suffered hemodynamic deterioration with extremely low cardiac output refractory to extracorporeal membrane oxygenation and intravenous catecholamine support, which was improved dramatically by bolus intravenous thiamine administration. Such a type with low cardiac output would be the most severe form of Shoshin beriberi, and cannot be rescued without diagnostic administration of thiamine.

The central pontine myelinosis is classically related with rapid correction of chronic hyponatremia. Recently, important additional factors have been described in the pathogenesis of this condition. We report the case of a 43-year-old alcoholic malnourished man, with acute renal failure with dialytic treatment, and output failure Shoshin beriberi. He had tetraplegy and coma. Confirmation of pontine and extrapontine myelinosis by magnetic resonance imaging, and abnormalities on auditive evoked potentials are described.

Shoshin is a fulminating form of cardiac beriberi developing in a few hours in a young alcoholic. Without specific treatment it evulers, toward death by cardiogenic shock and metabolic acidosis. Treatment by thiamine and alkalinisation permits a spectacular and fast recovery.

Author has noticed bilateral ophthalmoplegia in consequence of B1 avitaminosis due to alcoholism. Recognition of the cerebral beriberi with ophthalmoplegia as a leading symptom (Wernicke's encephalopathy) is easy. The importance of the diagnosis is that this life threatening condition can be abolished promptly by the administration of Vitamin B1. On the basis of the frequent occurrence of alcoholism it seems likely, that several similar beriberi cases could be found nowadays.

A man with chronic alcoholism presenting with recent-onset congestive heart failure and hyperdynamic features. Low arteriovenous oxygen content difference suggested high cardiac output. After 10 days of alcohol withdrawal, rest and balanced feeding the patient was asymptomatic and cardiomegaly subsided. No supplementation of thiamine was required.

Adults who had been drinking alcohol were admitted to hospital with severe lacticacidosis and died within two days. Empirical treatment with thiamine proved to be a cure for the disorder, for it was acute pernicious or fulminating beriberi. Thiamine deficiency is neglected as a cause of lacticacidosis.

The AA. report a case of thymine acute deficiency in a 35 year old chronic alcoholic and malnourished male, who was admitted to the hospital because of high-output heart failure, peripheral polyneuropathy, cortico-cerebellar atrophy (associated with RMN), ataxia and peripheral edema. The diagnosis of wet Beri-beri combined with Wernicke-Korsakoff syndrome was made and appropriate therapy with pulse daily dose of parenteral thymine instituted. At the fifth day of therapy the cardio-circulatory hyperkinetic syndrome was markedly improved and after three weeks neurological damage was also alleviated. The AA. outline the importance of early diagnosis and treatment for this form of high-output heart failure, which has a poor prognosis and, if left untreated, can determine the death of the patient in a few days.