Acute hearing and visual loss caused by thiamine deficiency

Abstract

Background: Wernicke encephalopathy (WE) is a devastating acute or subacute neurological disorder caused by thiamine deficiency. Wernicke encephalopathy is characterized by the triad of ocular signs, cerebellar dysfunction, and confusion. Visual loss and hearing loss are less common findings in WE. Here, we report a case of Wernicke encephalopathy in a nonalcoholic liver cirrhosis patient who presented with acute bilateral deafness and bilateral blindness. CASE PRESENTATION: A 60-year-old Chinese man presented with a history of bilateral blindness and bilateral hypoacousia for 3 days. He had a history of liver cirrhosis and chronic hepatitis C virus infection and did not have a habit of alcohol consumption. Ophthalmologic and otologic examinations showed no obvious abnormalities. MRI findings revealed symmetric fluid-attenuated inversion recovery (FLAIR) hyperintensities in the bilateral medial dorsal thalamus, periventricular region around the third ventricle and tectum, and dorsal medulla oblongata. One day after hospitalization, the patient developed a mild coma. Based on the laboratory and neuroimaging findings, we diagnosed the patient with Wernicke encephalopathy. He soon regained consciousness after administration of thiamine. Both his visual acuity and his hearing function improved gradually.

Conclusions: We suggest that Wernicke encephalopathy can present with bilateral blindness and bilateral deafness.

Keywords: Bilateral blindness; Bilateral hypoacousia; Liver cirrhosis; Wernicke encephalopathy.

Fig. 1 MRI of the brain. T2-FLAIR imaging demonstrated symmetric hyperintensities (arrows) in the bilateral medial dorsal thalamus (A), periventricular region around the third ventricle and tectum (B), and dorsal medulla oblongata (C). DWI demonstrated symmetric hyperintensities (arrows) in the bilateral medial dorsal thalamus (D), geniculate body (E), and the region around the periaqueductal grey matter (F)