A case of nonalcoholic Wernicke's encephalopathy due to an extreme diet based on magnetic resonance imaging features
DOI:
https://doi.org/10.13181/mji.v28i3.2629Keywords:
deficiency, fasting, thiamine, Wernickeâs encephalopathyAbstract
Wernicke's encephalopathy is a rare occurrence in Indonesia because alcohol consumption is very low. However, in Indonesia, Wernicke's encephalopathy could be triggered by an inadequate intake of thiamine (vitamin B1) due to an extreme diet for several months. It is a case of a 31-year-old male, who presented to the emergency room with a decreased level of consciousness. According to the family, for the last few weeks, he has become less responsive and less attentive. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) revealed a unique picture with symmetrical lesions in the bilateral medial thalamus, mammillary bodies, periaqueductal gray matter, and the dorsal surface of the medulla oblongata. Clinically, there is no neck stiffness and no fever. The laboratory results from the blood and cerebrospinal fluid have ruled out meningitis. Treatment with thiamine 200 mg t.i.d. has shown an excellent response and significant clinical improvement. The earlier thiamine substitution treatment is started, the better the outcome because thiamine will prevent further injury to the brain and enhance recovery.
Downloads
References
Guler A, Alpaydin S, Sirin H, Calli C, Celebisoy N. A non-alcoholic Wernicke's encephalopathy case with atypical MRI findings: clinic versus radiology. Neuroradiol J. 2015;28(5):474-7. https://doi.org/10.1177/1971400915598080
Galvin R, Bråthen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010;17(12):1408-18. https://doi.org/10.1111/j.1468-1331.2010.03153.x
Ropper AH, Samuels MA, Klein JP, Prasad S. Adam and Victor's principles of neurology. 10th Ed. New York: McGraw-Hill; 2014:1161-7.
Mkrtchyan G, Aleshin V, Parkhomenko Y, Kaehne T, Di Salvo ML, Parroni A, et al. Molecular mechanisms of the non-coenzyme action of thiamin in brain: biochemical, structural and pathway analysis. Sci Rep. 2015;5:12583. https://doi.org/10.1038/srep12583
Schabelman E, Kuo D. Glucose before thiamine for Wernicke encephalopathy: a literature review. J Emerg Med. 2012;42(4):488-94. https://doi.org/10.1016/j.jemermed.2011.05.076
Oudman E, Wijnia JW, Oey MJ, van Dam MJ, Postma A. Preventing Wernicke's encephalopathy in anorexia nervosa: a systematic review. Psychiatry Clin Neurosci. 2018;72(10):774-9. https://doi.org/10.1111/pcn.12735
Hutcheon DA. Malnutrition-induced Wernicke's encephalopathy following a water-only fasting diet. Nutr Clin Pract. 2015;30(1):92-9. https://doi.org/10.1177/0884533614561793
Onishi H, Ishida M, Tanahashi I, Takahashi T, Ikebuchi K, Taji Y, et al. Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic. Palliat Support Care. 2018;16(5):633-6. https://doi.org/10.1017/S1478951518000032
Dingwall KM, Delima JF, Gent D, Batey RG. Hypomagnesaemia and its potential impact on thiamine utilisation in patients with alcohol misuse at the Alice Springs Hospital. Drug Alcohol Rev. 2015;34(3):323-8. https://doi.org/10.1111/dar.12237
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
