Abstract
A 48-year-old woman, with a remote history of gastric-banding as well as recent-onset
post-prandial vomiting and excessive wine-drinking, was admitted with progressively-worsening
gait incoordination. She showed gaze-evoked nystagmus and gait ataxia. Brain MRI revealed
conspicuous, isolated, symmetrical T2/FLAIR-hyperintensities and gadolinium-enhancement
of the mammillary bodies. Serum thiamine and folate were low. Following thiamine and
folate replacement therapy, her ataxia resolved. Given the rising number of bariatric
procedures, we discuss the importance of recognizing thiamine-deficiency in these
patients. Additionally, while isolated involvement of the mammillary bodies is a rare
finding in this disorder, we highlight radiologic changes that neurologists should
recognize.
Keywords
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References
- Die acute, häemorrhagische Poliencephalitis superior.in: Wernicke C. Lehrbuch der Gehirnkrankheiten fur Aerzte und Studirende. vol. 2. Verlag von Throdor Fischer, Berlin1881: 229-242
- MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics.AJNR. 2009; 30: 171-176
- Wernicke encephalopathy after bariatric surgery: a systematic review.Ann Surg. 2008; 248: 714-720
- Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients.AJNR. August 2007; 28: 1328-1331
- Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management.Lancet Neurol. 2007; 6: 442-455
- A cluster of polyneuropathy and Wernicke–Korsakoff syndrome in a bariatric unit.Obes Surg. 2002; 12: 328-334
- A controlled study of peripheral neuropathy after bariatric surgery.Neurology. 2004; 63: 1462-1470
- Wernicke encephalopathy after obesity surgery: a systematic review.Neurology. 2007; 68: 807-811
- Development of Wernicke–Korsakoff syndrome after long intervals following gastrectomy.Arch Neurol. 1998; 55: 1242-1245
- Alcohol and poor compliance as factors in Wernicke's encephalopathy diagnosed 13 years after gastric bypass.Can J Surg. 1998; 41: 389-392
- Neurologic complications of gastric bypass surgery for morbid obesity.Neurology. 2007; 68: 1843-1850
- The Wernicke–Korsakoff Syndrome and related neurological disorders due to alcoholism and malnutrition.in: 2nd ed. Contemporary Neurology Series. F.A. Davis, Philadelphia, PA1989
- Clinical signs in the Wernicke–Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy.J Neurol Neurosurg Psychiatry. 1986; 49: 341-345
- Update of cell damage mechanisms in thiamine deficiency: focus on oxidative stress, excitotoxicity and inflammation.Alcohol Alcohol. 2009; 44: 141-147
- Selective response of various brain cell types during neurodegeneration induced by mild impairment of oxidative metabolism.Neurochem Int. 2004; 45: 361-369
- Wernicke's encephalopathy in nonalcoholic patients: clinical and pathologic features of three cases and literature reviewed.Neuropathology. 2006; 26: 231-235
- Brain and behavioral pathology in an animal model of Wernicke's encephalopathy and Wernicke–Korsakoff syndrome.Brain Res. 2012; 1436: 178-192
- Degeneration of anterior thalamic nuclei differentiates alcoholics with amnesia.Brain. 2000; 123: 141-154
- The incidence of Wernicke's encephalopathy in Australia — a neuropathological study of 131 cases.J Neurol Neurosurg Psychiatry. 1983; 46: 593-598
- Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature.AJR. 2009; 192: 501-508
- Ocular signs of Wernicke's disease.Trans Am Ophthalmol Soc. 1953; 51: 103-116
- Upbeat nystagmus changes to downbeat nystagmus with upward gaze in a patient with Wernicke's encephalopathy.J Neurol Sci. 2010; 298: 145-147
- The vestibulo-ocular reflexes during head impulse in Wernicke's encephalopathy.J Neurol Neurosurg Psychiatry. 2007; 78: 1161-1163
- Mamillary body enhancement of MR as the only sign of acute Wernicke encephalopathy.AJNR Am J Neuroradiol. 1994; 15: 172-174
- Clinical problem-solving. At a loss.N Engl J Med. 2012; 367: 67-72
Article info
Publication history
Published online: August 19, 2013
Accepted:
July 26,
2013
Received in revised form:
July 24,
2013
Received:
May 26,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
