Chepenko Kateryna, Rashid Muhammad Humayoun, Turabova Ulviyya, Kakhktsyan Tigran, Chadalawada Sindhu, Abdulsahib Ali, Mousa Aliaa, Bokhari Shafaq
Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.
Cureus. 2023 Jun 19;15(6):e40646. doi: 10.7759/cureus.40646. eCollection 2023 Jun.
Wernicke encephalopathy (WE) is a combination of neurological findings including confusion, ataxia, and ophthalmoplegia. It is most commonly associated with patients who have a history of alcohol abuse. This aspect leads to the majority of cases going undiagnosed in non-alcoholic patients who have other potential thiamine deficiency-causing conditions such as malignancy, chronic kidney disease (CKD) on hemodialysis, hyperemesis gravidarum, and psychiatric disorders leading to starvation and malnourishment. Here we present the case of a 59-year-old female patient with decompensated bipolar disorder who came in with altered mental status and multiple syncopal episodes. On examination, she was completely confused and had a fixed gaze. She was worked up for broad differential diagnoses including stroke, arrhythmias, seizures, drug intoxication, and infections. But due to her severely malnourished appearance, Wernicke's encephalopathy was suspected early on, and she was started on thiamine therapy, to which she responded well. It was also confirmed by an MRI of the brain showing flair in the bilateral medial thalamic region. Therefore, to suspect the presence of WE in non-alcoholic patients with psychiatric disorders and to differentiate behavioral symptoms from delirium and encephalopathy is difficult and requires a high degree of clinical suspicion.
韦尼克脑病（WE）是一种神经学表现的组合，包括意识模糊、共济失调和眼肌麻痹。它最常与有酗酒史的患者相关。这使得大多数病例在患有其他潜在导致硫胺素缺乏症的非酒精性患者中未被诊断出来，这些疾病包括恶性肿瘤、接受血液透析的慢性肾病（CKD）、妊娠剧吐以及导致饥饿和营养不良的精神疾病。在此，我们报告一例59岁患有失代偿性双相情感障碍的女性患者，她因精神状态改变和多次晕厥发作前来就诊。检查时，她完全意识模糊且目光固定。她接受了包括中风、心律失常、癫痫、药物中毒和感染等广泛鉴别诊断的检查。但由于她严重营养不良的外表，早期怀疑为韦尼克脑病，并开始给予硫胺素治疗，她对此反应良好。脑部MRI显示双侧内侧丘脑区域有信号增强，也证实了这一诊断。因此，怀疑患有精神疾病的非酒精性患者存在韦尼克脑病，并将行为症状与谵妄和脑病相鉴别是困难的，需要高度的临床怀疑。
