Nwaobi Samuel O, Thomas Denisia N, Ugoh Amaka C
Family Medicine, Piedmont Columbus Regional-Midtown, Columbus, USA.
Family Medicine, Edward Via College of Osteopathic Medicine, Auburn, USA.
Cureus. 2022 Jul 25;14(7):e27260. doi: 10.7759/cureus.27260. eCollection 2022 Jul.
Wernicke's encephalopathy (WE) is a manifestation of thiamine deficiency. The majority of affected patients are alcoholics and are adults. Often, clinicians fail to recognize that WE can also be found in non-alcoholic patients at risk for thiamine deficiency. Sometimes patients may not present with all the classic features, or the individual clinical signs may be treated as single problems and not a constellation of signs that form a diagnosis of WE. We present a unique case of a four-year-old male with a past medical history of food aversion who presented with intractable vomiting and weakness. The patient's clinical features showed signs of severe dehydration and weight loss. His clinical state subsequently progressed to having ophthalmoplegia and gait ataxia. Brain MRI demonstrated mamillary body changes, and serum thiamine level was significantly below the normal limit. Based on the patient's clinical assessment, deficient serum thiamine, and MRI findings, WE was diagnosed. The patient was evaluated by Pediatric Neurology and started on treatment with high dose IV thiamine. He showed an excellent response to thiamine treatment and had a significant resolution in his symptoms before discharge.
韦尼克脑病（WE）是硫胺素缺乏的一种表现。大多数受影响的患者是酗酒者且为成年人。通常，临床医生未能认识到WE也可出现在有硫胺素缺乏风险的非酗酒患者中。有时患者可能不会表现出所有典型特征，或者个别临床体征可能被当作单一问题处理，而不是作为构成WE诊断的一组体征。我们报告一例独特病例，一名4岁男性，有食物厌恶病史，出现顽固性呕吐和虚弱。患者的临床特征显示有严重脱水和体重减轻迹象。其临床状态随后进展为出现眼肌麻痹和步态共济失调。脑部磁共振成像（MRI）显示乳头体改变，血清硫胺素水平显著低于正常范围。根据患者的临床评估、血清硫胺素缺乏情况及MRI检查结果，诊断为WE。该患者由儿科神经科进行评估，并开始接受大剂量静脉注射硫胺素治疗。他对硫胺素治疗反应良好，出院前症状有显著缓解。
