There have been several reports of
disulfiram intoxication, but little evidence of neurologic conditions resulting from
disulfiram-induced brain damage combined with
Wernicke encephalopathy-associated lesions. We report a rare patient with both
Wernicke encephalopathy and
disulfiram intoxication. This 50-year-old woman, who was taking
disulfiram for chronic
alcohol abuse, presented with an acute
confusional state,
dysarthria, nystagmus, supranuclear
ophthalmoplegia, and
paraparesis. Biochemical serum and cerebrospinal fluid analyses were normal. An electromyogram detected a
motor polyneuropathy. Cognitive assessment revealed severe impairment of memory, attention, and logical and executive abilities. Magnetic resonance imaging with
gadolinium enhancement showed brain lesions consistent with
Wernicke encephalopathy, but also symmetric hyperintensities on T2-weighted images in the globus pallidus. Stopping the
disulfiram and treating with hydration, high-dose
thiamine supplements, and
benzodiazepines significantly improved the patient's consciousness and oculomotor function. A magnetic resonance imaging scan after 1 month of treatment showed complete disappearance of the brain lesions and the hyperintensities in the globus pallidus. After a further month of intensive
neurorehabilitation, the patient was able to interact with the medical staff, and her neuropsychological tests showed only mild memory impairment. Patients with
alcoholism who present at emergency departments are at high risk for misdiagnosis, especially because there is no specific routine laboratory test for detecting asymptomatic
disulfiram intoxication. Although uncommon, the combination of
Wernicke encephalopathy and
disulfiram intoxication should be suspected in patients with
alcoholism. The disorder can be detected through a careful history and prompt clinical evaluation, together with characteristic magnetic resonance imaging findings.