31 December 2020 : Case report
Mistake in diagnosisFaisal Khan12ABCDEF*, Neha Sharma3ABCDEF, Moin Ud Din3ABCDEF, Vivek Bansal4CDE
Am J Case Rep 2020; 21:e928272
BACKGROUND: Wernicke’s encephalopathy (WE), a commonly misdiagnosed and underdiagnosed pathology, presents with altered mental status, ataxia, and ophthalmoplegia. WE is most commonly caused by excessive alcohol use, but also has diverse nonalcoholic etiologies. Here we describe 2 cases of nonalcoholic WE with different etiologies that were initially misdiagnosed due to lack of correlation of magnetic resonance imaging (MRI) findings with clinical information.
CASE REPORT: Patient A, a 50-year-old woman with recent gastric sleeve surgery, presented with horizontal gaze-evoked nystagmus, ataxia, and altered mental status. MRI fluid-attenuated inversion recovery (FLAIR) revealed isolated bilateral, symmetrical, thalamic hyperintensities, initially diagnosed as variant Creutzfeldt-Jakob disease. A review of imaging and clinical presentation provided an alternate diagnosis of nonalcoholic WE secondary to nutritional deficiency. Intravenous (IV) thiamine improved symptoms with resolution of MRI findings 6 months later. Patient B, a 64-year-old woman, presented with nausea, vomiting, dizziness, altered mental status, and weight loss. MRI FLAIR revealed isolated bilateral, symmetrical, thalamic hyperintensities, initially determined to be ischemia, prompting stroke management. A diagnosis of nonalcoholic WE was suggested, given the patient’s low thiamine levels and history of malnutrition, and was confirmed by her excellent therapeutic response to IV thiamine.
CONCLUSIONS: Nonalcoholic WE remains a challenging diagnosis because of the variable clinical presentation, myriad of underlying etiologies, and lack of standardized diagnostic laboratory tests. A multidisciplinary approach with close collaboration between the radiologist and clinical care team is critical to narrow down the differential and initiate correct management. WE is a reversible disease with catastrophic consequences if it is not recognized and treated promptly.
Keywords: Creutzfeldt-Jakob Syndrome, Pulvinar, Thalamic Nuclei, Thiamine Deficiency, Wernicke Encephalopathy, Hockey, Magnetic Resonance Imaging, Middle Aged, thiamine
30 November 2022 : Case reportSevere COVID-19 in 2 Kidney Transplant Patients in Gabon
Am J Case Rep In Press; DOI: 10.12659/AJCR.938003
23 November 2022 : Case reportMepolizumab as a Potential Protective Factor of COVID-19 Mortality: A Case Report of Chronic Bronchitis and...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938450
01 November 2022 : Case reportCentral Retinal Vein Occlusion After Discontinuation of Rivaroxaban Therapy in a Young Patient with COVID-1...
Am J Case Rep 2022; 23:e937739
02 Dec 2022 : Case reportA 54-Year-Old Woman with Papillary Thyroid Carcinoma Associated with Secondary Amyloid Goiter and Thyroid L...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938156
02 Dec 2022 : Case reportA 14-Year-Old Saudi Boy with Gynecomastia, Cushing Syndrome, Large-Cell Calcifying Sertoli Cell Tumor of th...
Am J Case Rep In Press; DOI: 10.12659/AJCR.937404
01 Dec 2022 : Case reportUreterolithiasis in Human Immunodeficiency Virus (HIV) Patients Treated with Single-Use Ureteroscope: A Cas...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938608
Most Viewed Current Articles
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406