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Hypothermia, Wernicke encephalopathy and multiple sclerosis
1Department of Neurosciences, Henri Mondor Hospital, Créteil, France.
Abstract:
Neurological exacerbation observed in MS patients is usually related to a demyelinating process. We report two patients where hypothermia (32.4 degrees C and 32.5 degrees C) and neurological exacerbation were probably due to a Wernicke encephalopathy (WE). The clinical features and the rapid efficiency of parenteral thiamine were suggestive of WE. Hypothermia is an exceptional symptom observed in MS and has been considered as resulting from hypothalamic demyelination; these two cases showed that WE which is another cause of reversible hypothermia, can be associated with MS.
Insights
Neurological exacerbations in multiple sclerosis (MS) patients may signal Wernicke encephalopathy (WE), a reversible condition. Prompt thiamine treatment rapidly improved symptoms, including hypothermia, in two MS patients.
Area of Science:
- Neurology
- Neuroscience
- Internal Medicine
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, typically causing neurological exacerbations due to demyelination.
- Hypothermia is an uncommon symptom in MS patients, often attributed to hypothalamic demyelination.
- Wernicke encephalopathy (WE) is a serious neurological disorder typically associated with thiamine deficiency.
Observation:
- Two patients with MS presented with neurological exacerbation and hypothermia (32.4°C and 32.5°C).
- Clinical presentation and rapid response to intravenous thiamine strongly suggested WE as the cause.
- Hypothermia, usually linked to demyelination in MS, was observed in these cases.
Findings:
- Wernicke encephalopathy (WE) can manifest with hypothermia and neurological exacerbation in patients with multiple sclerosis (MS).
- Parenteral thiamine administration led to rapid clinical improvement, confirming WE as the likely diagnosis.
- This association highlights WE as a potential cause of reversible hypothermia in the MS population.
Implications:
- Highlights the importance of considering Wernicke encephalopathy in MS patients presenting with neurological decline and hypothermia.
- Suggests that prompt thiamine supplementation can reverse neurological symptoms and hypothermia in this specific patient group.
- Broadens the differential diagnosis for neurological exacerbations in MS, including non-demyelinating causes like WE.