Wernicke's Encephalopathy: A Different Case

Abstract

Background: Wernicke's encephalopathy (WE) is a neurologic disorder with acute onset, characterized by the triad of ocular abnormalities, ataxia and mental disorder. The etiology of the illness is vitamin B1 (thiamine) deficiency.
Objective: To report a case having clinical and radiologic findings typical of WE after operation. Case: A 56 year old man who had pancreas carcinoma presented with altered mental function followed by diplopia and blurry vision on the tenth day after the surgery. Neurologic examination revealed that he was mildly drowsy. His eye movements were extremely limited to all directions and had vertical and horizontal nystagmus. He had gait ataxia. Cranial MRI demonstrated abnormally increased signal in the perimesancephalic gray matter and the medial thalami on FLAIR images. These clinical and radiologic findings were consistent with WE. The patient improved dramatically within a week after thiamine administration. Conclusion: WE is associated with chronic alcoholism but also occurs due to other causes of malnutrition. Our case presented a reversible, abnormally increased signal in the perimesancephalic gray matter and thalamus, which are typical MR findings of WE; therefore, it worths reporting.