Recurrent Wernicke s Encephalopathy in a 16-Year-Old Girl with Atypical Clinical and Radiological FeaturesReport as inadecuate

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Case Reports in Neurological MedicineVolume 2014 2014, Article ID 582482, 6 pages

Case Report

Division of Neurology, Department of Medicine, Amiri Hospital, Arabian Gulf Street, Kuwait City, Kuwait

Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait

Received 27 November 2013; Accepted 31 December 2013; Published 10 February 2014

Academic Editors: P. Berlit and N. S. Litofsky

Copyright © 2014 S. Lamdhade et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Wernicke’s Encephalopathy WE is a clinical diagnosis with serious neurological consequences. Its occurrence is underestimated in nonalcoholics and is uncommon in adolescents. We aim to draw the attention to a rare case, which had additional clinical and radiological features. Case. A 16-year-old girl presented with three-week history of vomiting secondary to intestinal obstruction. She developed diplopia soon after hospitalization. Neurological evaluation revealed restriction of bilateral lateral recti with horizontal nystagmus, and bilateral limb dysmetria. Brain MRI was normal. She had prompt improvement to thiamine. Four months later, she presented with headache, bilateral severe deafness, and tinnitus. Clinically, she had severe sensorineural hearing loss, bilateral lateral recti paresis, and gait ataxia. CT head showed bilateral caudate nucleus hypodensities. MRI brain revealed gadolinium enhancement of mamillary bodies and vermis. She had significant improvement after IV thiamine. Headache completely resolved while the ocular movements, hearing, and tinnitus improved partially in 72 hours. Conclusions. Recurrent WE in adolescence is uncommon. Headache, tinnitus, and deafness are rare clinical features. Although MRI study shows typical features of WE, the presence of bilateral caudate nuclei hypodensities on CT scan is uncommon. Prompt treatment with thiamine is warranted in suspected cases to prevent permanent neurological sequelae.

Author: S. Lamdhade, A. Almulla, and R. Alroughani



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