# Wernicke's Encephalopathy Following 40 Days of Water‐Only Fasting: A Case Report

## TL;DR

A 36-year-old man developed Wernicke's encephalopathy after a 40-day water-only fast, highlighting the risk of thiamine deficiency in non-alcoholic cases.

## Contribution

This case report highlights WE caused by extreme fasting in a non-alcoholic individual, emphasizing the need for early thiamine treatment.

## Key findings

- A 36-year-old male developed WE after 40 days of water-only fasting.
- MRI showed bilateral medial thalami and periaqueductal hyperintensities consistent with WE.
- Treatment with high-dose thiamine and electrolyte correction led to significant improvement.

## Abstract

Wernicke's encephalopathy (WE) is an acute neurological disorder that develops due to thiamine (vitamin B1) deficiency. While it is common in chronic alcoholism, WE can also manifest due to other conditions, including extreme fasting. This report presents a unique case of WE occurring after a 40‐day water‐only fast, emphasizing the importance of recognizing nonalcoholic causes of WE. A 36‐year‐old male presented with diplopia, gait instability, and confusion following a 40‐day water‐only fast. Neurological examination revealed bilateral sixth cranial nerve palsy, ataxic gait, and confusion. Magnetic resonance imaging demonstrated bilateral medial thalami and periaqueductal hyperintensities, consistent with WE. He received high‐dose intravenous thiamine and electrolyte correction, resulting in substantial improvement. This case underscores the potential occurrence of WE in healthy individuals following extreme fasting. Early identification and treatment with thiamine are essential to prevent irreversible neurological damage. Clinicians should be cautious of WE in at‐risk patients without a history of alcohol use.