Wernicke's Encephalopathy due to Non-Alcoholic Gastrointestinal Tract Disease

Abstract

Introduction: Wernicke's encephalopathy (WE) is an underdiagnosed neuropsychiatric disorder especially in non-alcoholic groups that causes morbidity-mortality if diagnosis is delayed. Korsakoff syndrome is a chronic consequence of this condition characterized by persistent memory impairment. In this study we present a series of non-alcoholic patients with WE. The purpose of this study was to analyze the predisposing factors in non-alcoholic patients with WE and emphasize the importance of early diagnosis and treatment with thiamine supplementation.

Methods: The clinical records of 6 cases with WE followed by gastrointestinal tract disease and/or surgery who were admitted to our Medical Faculty between 2012 and 2014 were retrospectively reviewed.

Results: The study included 3 men and 3 women in the age range of 24 to 55. All patients had gastrointestinal tract diseases and/or had undergone gastrointestinal surgeries, and were non-alcoholic. Vomiting, weight loss, and parenteral nutrition were the frequent precipitating factors. The classic triad of mental impairment, oculomotor alterations and gait ataxia was present in 4 of the 6 patients. Magnetic Resonance Imaging showed typical signal alterations in the medial thalami, mammillary bodies and the periaqueductal region of patients in various degrees. Clinical improvement was seen in each patient after thiamine supplementation.

Discussion: Physicians should be aware of the predisposing factors and symptoms to prevent or optimize the management of this potentially devastating disease. Thiamine supplementation should be considered in patients with gastrointestinal tract diseases or those who have undergone surgery.

Keywords: Korsakoff syndrome; Wernicke-Korsakoff syndrome; Wernicke’s encephalopathy; thiamine deficiency; thiamine supplementation.

Figure 1

a. Axial T2 sequence MRI, showing the signal alterations in bilateral medial thalami, white arrows. b. DWI sequence MRI, showing the signal alterations in bilateral medial thalami, white arrows

Figure 2

a. Axial T2 sequence MRI; showing the bilateral signal alterations in the medial thalami, white arrows. b. FLAIR sequence MRI; showing the signal alterations in the mammillary bodies and periaqueductal region, white arrows. c. DWI sequence MRI; showing the bilateral signal alterations in the medial thalami, white arrows.

Figure 3

a. FLAIR sequence MRI; showing the marked signal alterations in the medial thalami, white arrows b. FLAIR sequence MRI; showing the marked signal alterations in slight changes in the mammillary bodies and periaqueductal region, white arrows c. DWI sequence MRI; showing the marked signal alterations in the medial thalami, white arrows

Figure 4

a. FLAIR sequence MRI; showing the slight bilateral signal alterations in the medial thalami MRI scan, white arrows b. DWI sequence MRI; showing the slight bilateral signal alterations in the medial thalami MRI scan, white arrows

Figure 5

a. Axial T2 sequence MRI showing the bilateral signal alterations in the medial thalami b. Axial T2 sequence MRI showing the signal alterations periaqueductal regions, white arrow.

Figure 6

a. FLAIR sequence MRI; showing the bilateral signal alterations in the medial thalami, white narrows. b. DWI sequence MRI; showing the bilateral signal alterations in the medial thalami, white narrows.