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Título

Wernicke's encephalopathy and polyneuropathy following intragastric balloon placement: a case report

RESUMO

Case presentation: A 42-year-old woman, with a previous medical history of hypertension, was brought to the emergency department with an acute confusional state that started five days prior to admission. No other symptoms were reported. The patient was submitted to an intragastric balloon (IGB) placement four months before the beginning of symptoms, with significant emesis following the procedure and retrieval of the IGB a week prior to admission. During the physical examination, upbeat nystagmus and clinical signs of polyneuropathy in the lower extremities were noticed. Concomitant to a thorough clinical and imaging evaluation, including the investigation, initial treatment and exclusion of potential causes, such as infectious and autoimmune encephalitis, the patient was treated with intravenous thiamine, which was followed by oral replacement. The diagnosis of Wernicke's encephalopathy was made clinically, although a specific imaging finding (mammillary body hemorrhage) was observed. She presented significant improvement regarding the cognitive impairment, as well as partial improvement of the ocular and motor symptoms. The patient is under physical therapy for rehabilitation and oral replacement of thiamine.

Discussion: Wernicke's encephalopathy is a potentially severe acute neurological condition caused by thiamine (B1) deficiency. Although typically described as a consequence of chronic alcohol abuse, malabsorptive weight loss surgeries are emerging causes. Restrictive procedures, such as intragastric balloon positioning, are not commonly associated with the condition and scarce reports are present in the literature. Here, we describe the case of a patient that was admitted with an acute confusional state and was diagnosed with Wernicke's encephalopathy after IGB placement. Given the potential severity of the condition and necessity of early treatment to prevent major neurological deficits, clinicians should be aware of this condition.

Final comments: The case presented demonstrates a possible, although rare, cause of Wernicke’s encephalopathy and polyneuropathy.