Wernicke's Encephalopathy With MRI Findings Despite Coadministration of Thiamine and Glucose

TL;DR

A patient with Wernicke's encephalopathy showed MRI changes and cognitive recovery after high-dose thiamine treatment, despite initial coadministration of thiamine and glucose.

Contribution

Demonstrates that WE can manifest with MRI findings even when thiamine is administered, highlighting diagnostic challenges.

Findings

MRI showed thalamic T2 signal changes consistent with WE despite thiamine administration.

High-dose thiamine led to rapid cognitive recovery in the patient.

The patient fully recovered and was discharged without complications.

Abstract

Wernicke's encephalopathy (WE) is a prominent neurologic manifestation of thiamine (vitamin B1) deficiency. While often linked to alcoholism, it can also arise from various causes, including malabsorption, inadequate dietary intake, increased metabolic requirement, and among dialysis patients. Here, we present a case of altered mental status from acute metabolic encephalopathy attributed to sepsis, acute kidney injury (AKI), and hypoglycemia. WE was overlooked in the early hospitalization course due to the daily administration of thiamine. However, the patient's cognitive decline persisted despite the improvement of sepsis and AKI. Subsequent brain MRI revealed thalamic T2 signal intensity changes, suggesting either a past infarction or WE. Implementing an empirical regimen of high-dose thiamine resulted in the patient's rapid cognitive recovery. This therapeutic strategy was integrated into the management of her sepsis and AKI, leading to her full recovery and subsequent hospital discharge without complications.

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