# From Starvation to Neurological Crisis: A Case of Wernicke’s Encephalopathy Triggered by Laxative Abuse

## TL;DR

A 56-year-old woman with anorexia and laxative abuse developed Wernicke's encephalopathy due to thiamine deficiency, but fully recovered after timely treatment.

## Contribution

Highlights a rare nonalcoholic cause of Wernicke's encephalopathy linked to laxative abuse and malnutrition.

## Key findings

- Chronic laxative misuse and severe malnutrition led to thiamine deficiency and WE.
- MRI confirmed typical WE brain abnormalities in the medial thalamic and periaqueductal regions.
- High-dose thiamine and nutritional support led to full neurological recovery within five days.

## Abstract

Wernicke's encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine deficiency, most commonly associated with chronic alcohol use, but it can also arise from rare nonalcoholic etiologies such as anorexia nervosa. This report describes a case of WE in a 56-year-old female patient with anorexia nervosa and chronic laxative misuse, presenting with altered mental status, disorientation, visual disturbances, and ataxia. Clinical evaluation revealed severe malnutrition (BMI 15.0 kg/m²) and multiple electrolyte abnormalities, while MRI findings demonstrated signal abnormalities in the bilateral medial thalamic and periaqueductal gray matter, consistent with WE. Chronic laxative abuse exacerbated thiamine depletion, leading to the development of WE. The patient was treated with high-dose intravenous thiamine and nutritional rehabilitation, resulting in complete recovery of neurological function within five days. This case emphasizes the importance of considering WE in malnourished patients presenting with encephalopathy, even in the absence of alcohol use, and highlights the critical role of early diagnosis, prompt thiamine replacement, and nutritional support in preventing irreversible neurological damage and ensuring recovery.