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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 62-63

Wernicke's encephalopathy: It not always alcohol


1 Department of Neurology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India
2 Department of Radiology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India

Date of Submission25-Jul-2020
Date of Decision10-Feb-2021
Date of Acceptance11-Feb-2021
Date of Web Publication22-Mar-2021

Correspondence Address:
Bindu Menon
Department of Neurology, Apollo Speciality Hospital, 16/111/1133, Muttukur Road, Pinakini Nagar, Nellore, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_85_20

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How to cite this article:
Menon B, Sharma M, Manam G. Wernicke's encephalopathy: It not always alcohol. Apollo Med 2021;18:62-3

How to cite this URL:
Menon B, Sharma M, Manam G. Wernicke's encephalopathy: It not always alcohol. Apollo Med [serial online] 2021 [cited 2021 Apr 11];18:62-3. Available from: https://www.apollomedicine.org/text.asp?2021/18/1/62/311630



A 16-year-old female child came to emergency with increasing sleepiness and forgetfulness of 10 days' duration. Parents reported that the patient had substantially reduced her diet and frequently skipped meals after having recently shifted to the hostel for her studies. Blood investigation was normal. Her magnetic resonance imaging (MRI) axial flair and T2-weighed images showed bilateral symmetrical hyperintensities in the mammillary bodies, periventricular region of the third ventricle, medial thalami, and periaqueductal area with corresponding diffusion-weighted imaging and apparent diffusion coefficient not showing any diffusion restriction [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d. The features were suggestive of Wernicke's encephalopathy (WE). The patient was given 500 mg thiamine followed by a maintenance dose for 2–3 days followed by oral medication. She showed dramatic improvement in her symptoms within 3 days and was asymptomatic after 3 months on follow-up with almost complete resolution of her MRI findings [Figure 2]a and [Figure 2]b.
Figure 1: Magnetic resonance imaging axial flair (a)and T2 weighed images (b)showing bilateral symmetrical hyperintensities in the mammillary bodies, periventricular region of third ventricle, medial thalami, and periaqueductal area with corresponding diffusion weighted imaging (c)and apparent diffusion coefficient (d)not showing any diffusion restriction

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Figure 2: Magnetic resonance imaging T2 weighted images (a,b) showing almost complete resolution of findings

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WE is an acute-onset neuropsychiatric disorder with the usual manifestation of the triad of symptoms of ataxia, oculomotor abnormalities, and confusional state due to Vitamin B1 deficiency.[1] Alcohol intake is the most common etiology.[2] However, nutritional deficiency can also produce WE. This case highlights that a high index of suspicion is needed for a favorable outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the parents have given their consent for images and other clinical information to be reported in the journal. The parents understand that names and initials will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Korsakoff's syndrome: a critical review. Arts NJM, Walvoort SJW, Kessels RPC. Neuropsychiatr Dis Treat. 2017;13:2875–2890.  Back to cited text no. 1
    
2.
Harper C, Fornes P, Duyckaerts C, Lecomte D, Hauw JJ.An international perspective on the prevalence of the Wernicke-Korsakoff syndrome. 1995;10:17-24. doi: 10.1007/BF01991779.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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