Restrictive diet in a patient with irritable bowel syndrome leading to Wernicke encephalopathy

Abstract

Background We present a case of a woman with a past medical history of irritable bowel syndrome (IBS) and anxiety, who presents with ophthalmoplegia, ataxia and memory loss, characteristic of Wernicke encephalopathy. Case presentation A 64-year-old woman presented with double vision, unsteady gait and memory loss. These symptoms began after 3 months on an unfortified restricted diet, which she initiated to alleviate IBS symptoms. Magnetic resonance imaging of the brain demonstrated hyperintense T2-weighted signal in the dorsomedial aspect of bilateral thalami, periaqueductal grey matter and around the third ventricle. The patient’s visual symptoms improved significantly after thiamine supplementation, although her memory deficits persisted. Conclusion Although WE is often associated with chronic alcohol abuse, this case demonstrates the importance of recognizing WE in any patient with a restricted diet and subsequent timely initiation of thiamine.

Acute hearing and visual loss caused by thiamine deficiency

“…Some studies have demonstrated that MRI has a high specificity but low sensitivity for WE [ 14 , 16 ]. However, a large number of researchers believe that MRI is a powerful and reliable tool that should be used to support the diagnosis of acute WE in both alcoholic and and nonalcoholic individuals [ 5 , 17 , 18 ].…”