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Case Reports in Neurological Medicine
Volume 2014 (2014), Article ID 430729, 5 pages
http://dx.doi.org/10.1155/2014/430729
Case Report

Nonalcoholic Wernicke’s Encephalopathy Associated with Unintentional Weight Loss, Cholecystectomy, and Intractable Vomiting: The Role of Dual Thiamine and Corticosteroid Therapy

1Department of Medicine, UPMC Mercy Hospital, Pittsburgh, PA 15219, USA
2Division of Critical Care Medicine, UPMC Mercy Hospital, Pittsburgh, PA 15219, USA
3Division of Neurology, UPMC Mercy Hospital, 1350 Locust Street, Suite 402, Pittsburgh, PA 15219, USA

Received 15 November 2013; Accepted 16 December 2013; Published 19 January 2014

Academic Editors: P. Berlit, H. Ikeda, and J. C. Kattah

Copyright © 2014 Vivek Verma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 23-year-old male with one month of intractable vomiting, subsequent cholecystitis status post cholecystectomy, and overall 40-pound weight loss over the last few months presented with altered mental status and seizures. MRI showed signal abnormalities involving the hypothalamus, periaqueductal gray matter, 4th ventricle, and bilateral thalami, indicative of Wernicke’s encephalopathy. The patient was started on empiric IV thiamine and methylprednisolone; thiamine levels were subsequently found to be low. Infectious disease workup was negative. Within a few days of this therapy, the patient’s neurological status steadily improved with increased responsiveness and communication. Repeat MRI 7 days after admission showed significant resolution of the signal abnormalities. Over the next several weeks the patient became fully conversational, cognitively intact, and increasingly ambulatory. Nonalcoholic Wernicke’s encephalopathy is rare; there have been reports relating it separately to vomiting and invasive surgery. In this case report, we associate it with both recurrent vomiting and minimally invasive cholecystectomy. We also discuss combinatorial therapy of thiamine and corticosteroids, which is poorly defined in the literature. Though there is no consensus-based optimal treatment of Wernicke’s encephalopathy, this adds to the discussion of using dual therapy and supports that the use of empiric corticosteroids does not harm the patient.