We report the case of a 67-year-old woman with
Wernicke's encephalopathy(WE), who had been suffering from repeated
vomiting and poor oral intake due to both
reflux esophagitis and
atrophic gastritis. She presented with altered of consciousness,
horizontal nystagmus, and gait disturbance, and acute deterioration of consciousness was observed after starting peripheral
parenteral nutrition (PPN). Brain MRI showed bilateral high intensity lesions in the medial thalamus and the dorsal midbrain on FLAIR and T2-weighted images. Although brain MRI characteristics are useful for diagnosing WE, it is possible that there are no abnormal MRI findings in its early stages. In addition, only 10-20% of WE cases present with the classical clinical triad of
confusion,
ophthalmoplegia, and
ataxia. Therefore, confirming the diagnosis can be challenging. In general, rapid improvement of symptoms is observed with prompt
vitamin B1 supplementation. However, delays in treatment can result in irreversible
amnesia and
ataxia. Furthermore, in the state of
vitamin B1 deficiency, even PPN, not just
total parenteral nutrition, can worsen symptoms, and this deterioration is attributed to the
glucose load.