Wernicke's encephalopathy in a non-alcoholic patient with hearing loss.

Abstract

Wernicke's encephalopathy is usually suspected when a patient presents with altered mental status, ataxy, and ocular motility disorders of acute or subacute onset, and a history of chronic alcoholism or hyperemesis gravidarum is noted. In recent decades, this disease has been identified in the context of numerous conditions that all have a common denominator: thianim deficiency. The classic triad described is only present in one-third of cases, and it is more common for some element of this triad to be identified in combination with other symptoms and signs of nervous system dysfunction. In this paper, we present the case of a young woman who, after several weeks of emetic syndrome related to acute cholecystitis, began to present paresthesias and proximal-distal muscle weakness in all four extremities. In the following hours and days, new symptoms gradually appeared, including gait instability, binocular diplopia, and fluctuating mental confusion. Physical examination revealed, among other signs, sensorineural hearing loss. Based on the clinical findings and the findings on the brain MRI, Wernicke's encephalopathy was suggested. The excellent response to treatment with high doses of thiamine reinforced the diagnosis.