Wernicke encephalopathy after chronic pancreatitis exacerbation. Case report

Abstract

Wernicke encephalopathy (WE), is an emergency acute neuropsychiatric condition, which develops secondary to thiamine deficiency. According to data of multiple investigations, this disorder is greatly underdiagnosed. WE classically connected to chronic alcohol abuse, but also diagnosed in non‑alcoholic patients with different risk factors including severe vomiting, chronic malnutrition, systemic infections, malignancies, chemotherapy, HIV/AIDS, gastrointestinal surgeries or disease, and renal problems. We present a case of a 33‑year‑old woman with history of chronic pancreatitis exacerbation with prolonged vomiting, present to the neurological department with neurological symptoms consistent with WE. WE was suspected according to triad of symptoms, such as altered mental state, oculomotor disturbances and ataxia. Brain magnetic resonance imaging (MRI) and thiamine blood level aid us to confirm WE diagnosis. The patient was given thiamine, at the dosage of 200 mg 3 times per day intravenously for seven days, followed by oral thiamine. Gaze paresis disappeared at day 10, truncal ataxia noticeably improved after two weeks. The patient was left with some signs of anterograde amnesia, gaze‑provoked nystagmus at the two month follow‑up. Physicians should be familiar with clinical presentation of WE in non‑alcoholic patients with appropriate history and risk factors, like prolonged emesis, unbalanced diet, malignancies, etc. Presence of classic triad of clinical symptoms and pathological findings on brain MRI are the most important diagnostic tool, while the blood thiamine level may be within the normal range. Early diagnosis and therapy onset are crucial for patients to prevent further irreversible complications or death.