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[Case of Wernicke's encephalopathy and subacute combined degeneration of the spinal cord due to vitamin deficiency showing changes in the bilateral corpus striatum and cardiac arrest due to beriberi heart disease].

Abstract
A 52-year-old woman was admitted to the hospital because of appetite loss, unsteadiness, psychogenic symptoms, ataxia, and consciousness disturbance as a result of the ingestion of a diet restricted to only carbohydrates for a long term. Laboratory examination indicated the presence of pancytopenia with macrocytic anemia; further, decreased vitamin B1 and B12 levels were detected in her serum. Magnetic resonance imaging fluid attenuated inversion recovery (FLAIR), revealed high-signal intensity in the bilateral corpus striatum, third ventricle circumference, and cerebellar cortex. Thereafter, she received drip infusion that did not include vitamin B1 or B12 and subsequently suffered a cardiac arrest due to the aggravation of cardiac insufficiency; consequently, she was transferred to our hospital. Upon admission the patient was diagnosed to have obvious cardiomegaly with pleural effusion; further, a negative T-wave was obtained on the electrocardiogram. A diagnosis of beriberi heart disease was made because of thiamine deficiency. She was treated by thiamine administration, following which the cardiac symptoms improved immediately. Various neurological symptoms caused by encephalopathy, peripheral neuropathy and subacute combined spinal cord degeneration improved by treatment with thiamine and cyanocobalamine administration; however, some of these symptoms still remained. General awareness of the fact that neurological symptoms can be caused by vitamin deficiency is essential.
AuthorsTomoko Ishiko, Takeshi Taguchi, Masafumi Takeguchi, Hirohiko Saito, Kazunori Nanri
JournalBrain and nerve = Shinkei kenkyu no shinpo (Brain Nerve) Vol. 61 Issue 9 Pg. 1069-73 (Sep 2009) ISSN: 1881-6096 [Print] Japan
PMID19803406 (Publication Type: Case Reports, English Abstract, Journal Article)
Chemical References
  • Folic Acid
  • Vitamin B 12
  • Thiamine
Topics
  • Beriberi (diagnosis, drug therapy, etiology)
  • Cardiomegaly (diagnosis, drug therapy, etiology)
  • Corpus Striatum (pathology)
  • Female
  • Folic Acid (administration & dosage)
  • Folic Acid Deficiency (complications)
  • Heart Arrest (diagnosis, drug therapy, etiology)
  • Humans
  • Middle Aged
  • Subacute Combined Degeneration (diagnosis, drug therapy, etiology)
  • Thiamine (administration & dosage)
  • Thiamine Deficiency (complications, diagnosis, drug therapy)
  • Treatment Outcome
  • Vitamin B 12 (administration & dosage)
  • Vitamin B 12 Deficiency (complications, diagnosis, drug therapy)
  • Wernicke Encephalopathy (diagnosis, drug therapy, etiology)

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