[Wernicke's encephalopathy associated with chronic disulfiram intoxication].

Abstract

INTRODUCTION:

We report the case of a patient with an unusual association of Wernicke encephalopathy and chronic disulfiram intoxication.

CASE REPORT:

A 41-year-old man presented with progressive frontal decline and akineto-rigid parkinsonism under chronic disulfiram therapy. He also developed acute confusion with ataxia, blepharospasm, and supranuclear ophthalmoplegia following a severe malnutrition due to refusal of food intake. Brain MRI revealed symmetrical and reversible hyperintense lesions on T2 and FLAIR in the posterior putaminal regions, dorso-medial thalamic and subthalamic nuclei, the periaqueducal gray matter, the cerebellar peduncles, and the pontine tegmentum. A slow partial clinical recovery with persistent frontal syndrome was observed after discontinuation of disulfiram and parenteral administration of thiamine.

DISCUSSION:

The symmetry and reversibility of the MRI lesions in the basal ganglia and brain stem were suggestive of a deficiency, a toxic or a metabolic neurological disease. The dorso-medial thalamo-subthalamic and brainstem localizations, as well as their occurrence in a state of malnutrition, were consistent with Wernicke encephalopathy. Moreover, chronic disulfiram intoxication might explain the frontal syndrome and the akineto-rigid parkinsonism, associated with MRI putaminal lesions. Similar MRI lesions have been described in the so-called "energy deprivation syndromes", which are toxic, genetic or nutritional disorders that disrupt enzymes involved in energy generating metabolic pathways such as glycolysis and pyruvate oxidation.

• Authors: V Charles, S Boulvin, F Haven, M Gille
• Journal: Revue neurologique (Rev Neurol (Paris)) Vol. 162 Issue 12 Pg. 1252-6 (Dec 2006) ISSN: 0035-3787 [Print] France
• Vernacular Title: Encéphalopathie de Gayet-Wernicke associée a une intoxication chronique au disulfiram.
• PMID: 17151518 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Disulfiram

Topics

• Adult
• Disulfiram (poisoning)
• Humans
• Magnetic Resonance Imaging
• Male
• Parkinson Disease (complications, pathology)
• Wernicke Encephalopathy (etiology, pathology)