Wernicke Encephalopathy Caused by Avoidance-Restrictive Food Intake Disorder in a Child: A Case-Based Review

Diseases Pub Date : 2024-05-24 DOI:10.3390/diseases12060112
Ida Turrini, Clotilde Guidetti, I. Contaldo, S. Pulitanò, D. Rigante, Chiara Veredice
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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.
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儿童回避-限制性食物摄入障碍引发的韦尼克脑病:基于病例的回顾
背景:韦尼克脑病(Wernicke encephalopathy,WE)是一种由硫胺素缺乏引起的急性、潜在致命的神经精神疾病:其病因和临床表现多种多样,难以识别,尤其是在儿童和青少年中。病例介绍:一名 8 岁女孩因反复剧烈呕吐 10 天后出现共济失调步态、眼球震颤和精神错乱而被送入急诊室;其近期临床病史的特点是因窒息恐惧症而限制营养,导致体重大幅下降。脑磁共振成像显示,丘脑内侧区域和大脑下隐窝区域的T2信号双侧增高。根据临床和神经放射学检查结果,确定了WE的诊断,并在实验室检查显示血清硫胺素偏低后予以确诊。经过精神评估,患者还被诊断为回避-限制性食物摄入障碍(ARFID),需要开始认知行为疗法并使用阿立哌唑。一个月后,患者的放射学检查结果有所改善,神经系统症状和体征也完全消失。结论ARFID等进食障碍可能会先于WE的急性症状出现;即使是儿童患者也应考虑到这种可能性,尤其是当出现不典型的神经症状或进食问题时。
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