Wernicke encephalopathy: late-stage symptoms

Aleksandra Lučić Prokin; Vladimir Galić; Timea Kokai Zekić; Vedran Žigić

doi:10.5937/afmnai42-50220

Aleksandra Lučić Prokin Klinika za neurologiju, Unverzitetski klinički centar Vojvodine
Vladimir Galić Klinika za neurologiju, Unverzitetski klinički centar Vojvodine
Timea Kokai Zekić Klinika za neurologiju, Unverzitetski klinički centar Vojvodine
Vedran Žigić Centar za radiologiju, Univerzitetski klinički centar Vojvodine

DOI: https://doi.org/10.5937/afmnai42-50220

Abstract

Introduction: Wernicke's encephalopathy is a rare acute/subacute neurological disorder, commonly caused by prolonged thiamine deficiency in patients who chronically consume alcohol. According to the Caine classification criteria, the clinical diagnosis of this encephalopathy involves at least two of the following four signs: malnutrition, oculomotor dysfunction, ataxia, and changes in mental status. This case report highlights rare clinical signs in the late stage of the disease, as well as the consequences of possible local hypoperfusion of the brainstem in the form of an ischemic vascular event.

Case presentation: A 39-year-old female patient (previously treated at a regional general hospital) was admitted to the Department of emergency neurology at the University clinical center of Vojvodina with a history of a series of epileptic seizures, altered consciousness, oculomotor signs, opisthotonus, and cognitive dysfunction, following years of alcohol consumption and nutritional deficiency. The diagnosis was confirmed by typical neuroimaging findings and specific laboratory tests. Opisthotonus/hypertonia was an unexpected clinical manifestation of Wernicke's encephalopathy, as well as the occurrence of an ischemic stroke. Empirical administration of high-dose thiamine, along with additional supportive intensive therapy, did not yield satisfactory outcomes.

Conclusion: Wernicke's encephalopathy represents a clinical diagnosis based on physical and neurological examination, with neuroimaging. Early recognition of both common and unusual symptoms, particularly in the late stage of the disease, could potentially reduce morbidity and mortality. It is essential to administer thiamine before glucose infusion to all patients with an undetermined cause of altered consciousness.

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