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Título

WERNICKE ENCEPHALOPATHY: A LIFE-THREATENING CONDITION, PASSIVE TO REVERSIBILITY IN THE FACE OF EARLY CLINICAL RECOGNITION

RESUMO

CASE PRESENTATION: Patient, male, 43 years old, chronic alcoholic, presented a fall from his own height, evolving with ataxic gait and visual clouding. After the 4th day, he presented worsening of symptoms with acute mental confusion, vertigo syndrome, headache and vomiting. On neurological examination: Vigil with spatial disorientation, Mini Exam of the Mental State : 18 points, Clock test: hit the circle, missed orders of numbers; Vertical Nystagmus at rest and horizontal at the lateral view on both sides; Skew Deviation; tremor of the extremities, ataxic gait, dysbasis with fall to the Romberg maneuver without latency , with preferential side to the right, and vibratory hypoesthesiav in the left foot. Among the tests, LDH 594; GGT 902; TGP 696; TGO 642; RT PCR SARs-COV2 positive. Skull MRI showed hypersignal in nipple bodies and in the bilateral medial thalamic region, in FLAIR. Treatment performed with intramuscular (IM) thiamine for 7 days, progressing with significant improvement in ataxia and partial improvement of nystagmus, but maintained the mental confusion. He was discharged from hospital, with oral thiamine prescription, for 24 months.DISCUSSION: Wernicke's encephalopathy (WE), thiamine deficiency, should be part of the differential diagnoses of acute/subgued ataxic syndromes, especially in the context of chronic alcoholism. The patient in the case described has 3 of the 4 CAINE criteria for clinical diagnosis (acute encephalopathy; oculomotor dysfunction and ataxic gait). Laboratory tests show changes in the markers of liver and canalicular injury, secondary to the chronicity of alcohol consumption. Although neuroimaging is not essential for the diagnosis, its important to the exclusion of other diagnoses, and corroborates the hypothesis of WE: acute diencephalic and periventricular lesions in the III and IV ventricles, and atrophy of nipple bodies are specifics findings. In the suspicion of the diagnosis, patients should receive immediate administration of thiamine, preferably intravenously. Given the unavailability in the service, it had been performed IM. FINAL CONSIDERATIONS: The acute evolution of mental confusion or ataxia should have WE as a differential diagnosis, considering the risk factors for vitamin B1 deficiency. Despite being a clinical diagnosis, it continues to be underdiagnosed, even though it is a treatable and reversible neurological emergency, early non-recognition can result in unfavorable outcomes: coma and death.

Palavras Chave

Wernicke Encephalopathy; Ataxia;