Atypical Wernicke′s syndrome sans encephalopathy with acute bilateral vision loss due to post-chiasmatic optic tract edema

Desai, Soaham; Shah, Diva

doi:10.4103/0972-2327.128567

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…WS or atypical WE is a term to describe patients whose presentation does not necessarily meet all three criteria or classic triad (ie, mental status changes, ataxia and ophthalmoplegia) of WE 11…”

Section: Discussionmentioning

confidence: 99%

Atypical Wernicke’s encephalopathy without mental status changes following bariatric surgery in an adolescent patient

Akbar,

Lowther,

Creeden

et al. 2024

BMJ Case Rep

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Morbid obesity is a systemic disease which can result in chronic complications, including hypertension, diabetes mellitus, depression, osteoarthritis and low self-esteem in the adolescent population.Bariatric surgery can be indicated to treat more severe forms of obesity, but these procedures are not without long-term risks. Therefore, adequate preoperative and postoperative care, which includes preoperative psychosocial evaluation for compliance, ongoing nutrition counselling and vitamin and micronutrient supplementation, is required for all patients, especially adolescent patients, who generally may not comply with medical therapies and/or be able to developmentally fully appreciate or comprehend the health consequences of their behaviours, prior to as well as after bariatric surgery to prevent complications.Thiamine pyrophosphate, an active form of thiamine (also known as vitamin B1, a water-soluble vitamin), which functions as a coenzyme in glucose and energy metabolism, is one such vitamin that requires supplementation postoperatively. It is mandatory for glucose to be administered concomitantly with thiamine, as glucose alone can precipitate Wernicke’s encephalopathy (WE) in thiamine-deficient individuals. WE is a medical emergency, with a mortality rate of up to 20%. WE is best understood as a classic triad of mental confusion, gait ataxia and eye movement abnormalities, and atypical WE or Wernicke’s syndrome (WS) is seen when the classic triad is not present. Cases that meet some, but do not necessarily meet all three criteria, are referred to as atypical WE or WS which can lead to delayed diagnosis. Atypical WE has an incidence of 19% which can lead to misdiagnosis of a preventable medical emergency with fatal complications.The following case reviews the consequences of post-bariatric thiamine supplementation therapy non-adherence and resulting in a deficiency in an adolescent patient.

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Section: Discussionmentioning

confidence: 99%

Atypical Wernicke’s encephalopathy without mental status changes following bariatric surgery in an adolescent patient

Akbar,

Lowther,

Creeden

et al. 2024

BMJ Case Rep

View full text Add to dashboard Cite

show abstract

“…30 While the classic triad for Wernicke encephalopathy is gait ataxia, ophthalmoplegia, and encephalopathy, the caveat for diagnosis is that with incomplete presentations of the triad, varying degrees of oculomotor dysfunction and atypical manifestations such as a stroke mimic have been frequently reported. 31 32 33 Similarly, while Wernicke encephalopathy typically affects midline structures such as thalamus, mammillary bodies, and periaqueductal gray matter, in addition to the cerebellar hemisphere and superior anterior vermis, 30 34 a wide range of radiographic findings have been reported, including stroke-like cortical T2 hyperintensity or the absence of an overt imaging abnormality. 33 35 36 Given that ataxia associated with thiamine deficiency is treatable, patients with ataxia and risk factors for nutritional deficiency should be treated empirically with high-dose intravenous thiamine to avoid devastating brain hemorrhage, 37 preferably after sending a test of whole blood thiamine level.…”

Section: Nutritional Deficiency Cerebellar Ataxiamentioning

confidence: 99%

Ataxias: Hereditary, Acquired, and Reversible Etiologies

Lin

Kuo

2023

Semin Neurol

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A variety of etiologies can cause cerebellar dysfunction, leading to ataxia symptoms. Therefore, the accurate diagnosis of the cause for cerebellar ataxia can be challenging. A step-wise investigation will reveal underlying causes, including nutritional, toxin, immune-mediated, genetic, and degenerative disorders. Recent advances in genetics have identified new genes for both autosomal dominant and autosomal recessive ataxias, and new therapies are on the horizon for targeting specific biological pathways. New diagnostic criteria for degenerative ataxias have been proposed, specifically for multiple system atrophy, which will have a broad impact on the future clinical research in ataxia. In this article, we aim to provide a review focus on symptoms, laboratory testing, neuroimaging, and genetic testing for the diagnosis of cerebellar ataxia causes, with a special emphasis on recent advances. Strategies for the management of cerebellar ataxia is also discussed.

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“…When vision loss does occur, it is typically bilateral and severe. There are case reports of patients with Wernicke's syndrome who experienced vision loss in the absence of retinal/ optic disc changes on exam, and these have been attributed to postchiasmal or cortical changes from thiamine deficiency [12 ▪ ,13].…”

Section: Clinical Presentationmentioning

confidence: 99%

Approach to the diagnosis and management of nutritional optic neuropathies

Bhat

Bakaeva

2022

Current Opinion in Ophthalmology

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Purpose of reviewNutritional deficiency is an under-recognized cause of optic neuropathy. The purpose of this review is to discuss how to identify, diagnose, and appropriately manage patients with nutritional optic neuropathy.Recent findingsNutritional deficiencies have long been thought to be more prevalent in the developing countries. However, with the advent of bariatric surgery, restrictive/selective diets, and the increase in alcohol dependence, it is not uncommon to see nutritional optic neuropathies in the developed world.SummaryAlthough nutritional optic neuropathy can cause severe and debilitating vision loss, it is often reversible when it is diagnosed and treated in a timely manner.

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Atypical Wernicke′s syndrome sans encephalopathy with acute bilateral vision loss due to post-chiasmatic optic tract edema

Cited by 6 publications

References 10 publications

Atypical Wernicke’s encephalopathy without mental status changes following bariatric surgery in an adolescent patient

Atypical Wernicke’s encephalopathy without mental status changes following bariatric surgery in an adolescent patient

Ataxias: Hereditary, Acquired, and Reversible Etiologies

Approach to the diagnosis and management of nutritional optic neuropathies

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