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Título

Wernicke's Encephalopathy due to Acute Pancreatitis

RESUMO

Case Report: N.L.S, 19 years old, is reported to the ER, in Salvador - BA, on 04/23/2021, complaining of epigastric pain and vomiting for 30 days, with worsening in the last 24h of admission. She carried an outpatient ultrasound suggestive of acute cholecystitis. Therefore, the possibility of acute biliary pancreatitis was considered. Diet restriction and partial parenteral nutrition were started, with maintenance of nausea and vomiting, being then escalated to total parenteral nutrition on 04/27. On 05/04, she developed fever, tachycardia with leukocytosis. The assistent team prescribed Meropenem and Teicoplanina. Abdominal CT shows slightly hyperattenuating content inside the gallbladder. On 09/05, she evolved with a lowered level of consciousness, GCE 8, being subjected to orotracheal intubation for airway protection. The neurology team is called in to assess the condition. Findings of ataxia, multidirectional ophthalmoparesis, nystagmus, tetraparesis and global hyperreflexia were identified. Two cranial CT were performed without acute changes. Cranial MRI was performed, which showed hypersignal on T2/FLAIR and in the diffusion sequence, affecting the medial and posterior portion of the thalami bilaterally and symmetrically. Such findings are superimposable to those observed in Wernicke's encephalopathy. The patient received IV thiamine replacement in 05/14, presenting an almost complete reversal of the clinical presentation. Discussion: Wernicke's encephalopathy (WE) is a rare condition associated with thiamine deficiency, characterized by neurological symptoms such as ataxia, nystagmus, tremors, paresis and cognitive impairment. Although very associated with chronic alcoholism, it is present in 12.5% of the autopsies of addicts, the condition is also associated with situations of malabsorption, poor dietary intake, increased metabolic requirement or in situations of accentuated loss of thiamine (hemodialysis). However, other less common etiologies are described, such as prolonged fasting associated with other pathologies, as acute pancreatitis. The diagnosis of WE is difficult to confirm, and if untreated, patients progress to coma and death. Fortunately, IV administration of thiamine is safe, simple, inexpensive, and effective. Diagnostic tests, therefore, should not delay treatment. Conclusion: It is essential to prevent thiamine deficiency in cases of acute pancretitis, as well as early recognition of the clinical picture.

Palavras Chave

Wernicke's encephalopathy; thiamine deficiency; acute pancreatitis