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
18 January 2022 : Case reportSickle Cell Trait and SARS-CoV-2-Induced Rhabdomyolysis: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.934220
11 January 2022 : Case reportMyocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
Am J Case Rep In Press; DOI: 10.12659/AJCR.934399
12 January 2022 : Case reportGuillain-Barré Syndrome After Ad26.COV2.S Vaccination
Am J Case Rep In Press; DOI: 10.12659/AJCR.935275
19 Jan 2022 : Case reportRare Case of Hodgkin Lymphoma Transformation into Diffuse Large B-Cell Lymphoma with Atypical Spread Epidur...
Am J Case Rep In Press; DOI: 10.12659/AJCR.935014
19 Jan 2022 : Case reportAutoimmune Hemolytic Anemia – Rare Complication of Brucellosis in a Saudi Woman: A Case Report and Literatu...
Am J Case Rep In Press; DOI: 10.12659/AJCR.935187
18 Jan 2022 : Case reportAnnular Epidermolytic Ichthyosis Mimicking Greither Disease: A Case Report and Literature Review
Am J Case Rep In Press; DOI: 10.12659/AJCR.935393
Most Viewed Current Articles
10 Jan 2022 : Case reportA Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...
Am J Case Rep 2022; 23:e935263
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
24 Jul 2020 : Case reportSymptoms of Pleurisy as the Initial Presentation of COVID-19
Am J Case Rep 2020; 21:e925775