Editorial Comment: Ataxia, Ophthalmoplegia, and Impairment of Consciousness in a 19 Month-Old American Boy

The authors describe a classic neurologic syndrome in an unusual setting. Wernicke encephalopathy is most commonly encountered in malnourished adults, particularly those who abuse alcohol. It is not generally high in the differential diagnosis of childhood disorders, particularly in children who are otherwise ostensibly well, but it is critical to diagnose, owing to its potential reversibility with early treatment. This elegant report beautifully outlines the diagnostic process, differential diagnosis, and recognition of the key findings—the combination of acute ataxia and ophthalmoplegia with altered mental status as the hallmark of acute thiamine deficiency. The authors also emphasize the importance of a thorough evaluation of dietary history, which revealed the underlying nutritional deficiency in the child they describe. In this case, neuroimaging clinched the diagnosis before biochemical confirmation was available.
Source: Seminars in Pediatric Neurology - Category: Neurology Authors: Source Type: research

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Conclusion: Substitution of parenteral thiamine in individuals with suspected WE is a well-established treatment regimen. However, suggestions according to guidelines vary widely. Furthermore, hardly any evidence-based recommendations exist on a more general use of thiamine as a preventative intervention in individuals with AUD. Further research is of utmost importance to raise awareness for this potentially undervalued problem.Eur Addict Res 2019;25:103 –110
Source: European Addiction Research - Category: Addiction Source Type: research
This report describes a case of Wernicke encephalopathy developing in a patient with brid ileus and receiving total parenteral nutrition after partial ileal bypass surgery. The patient's clinical and cranial magnetic resonance findings were compatible with Wernicke encephalopathy. Although these are not widespread, typical ocular findings for Wernicke encephalopathy were present. Dramatic improvements were observed in clinical, ocular, and cranial magnetic resonance findings after treatment.
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Illustrative Cases Source Type: research
Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions. Once identified, nutritional supplementation and cessation measures are critical in preventing further neurologic damage. The proposed mechanisms of neuronal injury in chronic alcohol abuse include direct toxic effects of alcohol and indirect effects, including those resulting from hepatic dysfunction, nutritional deficiencies, and neuroinflammation. Clinical manifestations include cerebellar ataxia, peripheral neuropathy and Wernicke-Kors...
Source: Clinics in Liver Disease - Category: Gastroenterology Authors: Source Type: research
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 155 Author(s): Mario Manto, Gaetano Perrotta The cerebellum is a brain region which is particularly susceptible to intoxication. Clinical presentation is heterogeneous. It is often considered that elderly patients and patients presenting pre-existing structural lesions of the posterior fossa are particularly at risk of developing a toxic-induced cerebellar syndrome (TOICS). However, TOICS may occur at any age, including in utero. Indeed, the cerebellum is highly vulnerable during neurodevelopment. Amongst cerebellotoxic agents, ethanol is the most common...
Source: Handbook of Clinical Neurology - Category: Neurology Source Type: research
Authors: Moretti R, Caruso P, Dal Ben M, Gazzin S, Tiribelli C Abstract Drinking more than the recommended limits is a worldwide emerging problem, difficult to circumscribe, and alcohol related brain damages are an under-recognized health problem. Alcohol-cognitive disruption can be considered as transient and recoverable if the alcohol consumption is limited and occasional; if not, it can progress to the so-called alcohol-related dementia (ARD), or to the Wernicke encephalopathy, or it can even induce the Korsakoff syndrome, an irreversible and long-lasting medical condition. ARD still remains poorly diagnosed and...
Source: Current Drug Abuse Reviews - Category: Addiction Tags: Curr Drug Abuse Rev Source Type: research
We examined neurological and nutritional factors as possible contributors to heterogeneity in impairment. Participants with ALC (n = 96) and a normal comparison group (n = 41) were examined on six cognitive and motor domains. Signs of historically determined subclinical Wernicke's encephalopathy were detected using the Caine et al. criteria, which were based on postmortem examination and chart review of antemortem data of alcoholic cases with postmortem evidence for Wernicke's encephalopathy. Herein, four Caine criteria provided quantification of dietary deficiency, cerebellar dysfunction, low general c...
Source: Addiction Biology - Category: Addiction Authors: Tags: Original Article Source Type: research
Authors: Chen BA, Chen LC Abstract Wernicke's encephalopathy (WE) is a disease caused by thiamine deficiency related to alcoholism, hyperemesis, or thiamine malabsorption. The clinical manifestations of WE are mental change, ataxia, and ophthalmoplegia. The typical magnetic resonance imaging (MRI) findings of WE are symmetrical involvement of medial thalamus, periventricular region of the third ventricle, periaqueductal area, and mammillary body. The atypical MRI findings are more common in nonalcoholic WE. Since the increasing population of obesity and the preference of weight loss surgery, the risk of developing ...
Source: Acta Neurologica Taiwanica - Category: Neurology Tags: Acta Neurol Taiwan Source Type: research
We present a 37-year-old woman who underwent laparoscopic sleeve gastrectomy and presented with visual disturbance with bilateral horizontal nystagmus, confusion, and postural imbalance. Fundus examination revealed bilateral optic disc edema with a retinal hemorrhage in the left eye. Metabolic workup demonstrated thiamine deficiency. Her symptoms resolved after thiamine treatment. This case raises the awareness of the possibility of posterior segment findings in WE, which are underreported in WE.Case Rep Ophthalmol 2017;8:406 –409
Source: Case Reports in Ophthalmology - Category: Opthalmology Source Type: research
Conclusions:Our case may be the first reported of isolated inferior rectus palsy induced by thiamine deficiency. Clinicians should include thiamine deficiency in their differential of partial, pupillary sparing 3rd nerve palsy. Thiamine levels should be included in the diagnostic evaluation of inferior rectus weakness particularly if risk factors for thiamine deficiency are present.Disclosure: Dr. Fares has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Neuro-ophthalmology/Neuro-otology I Source Type: research
Conclusions:There should be a high clinical suspicion to diagnose Wernicke Encephalopathy in patients who are not alcoholics. Malnutrition and starvation can lead to Wernicke Encephalopathy, early diagnosis is important for definite treatment with thiamine.Disclosure: Dr. Panjwani has nothing to disclose. Dr. Humayun has nothing to disclose. Dr. Pirzada has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Behavioral and Cognitive Neurology: Cognitive Deficits in Neurological Disorders Source Type: research
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