Elevated cerebrospinal fluid tau in Wernicke encephalopathy

Area of Science:

• Neurology
• Neuroscience
• Biochemistry

Background:

• Wernicke encephalopathy (WE) presents with neurological deficits and can mimic rapidly progressive dementia syndromes like Creutzfeldt-Jakob disease (CJD).
• Cerebrospinal fluid (CSF) tau protein levels are utilized in diagnosing dementia subtypes, particularly CJD and Alzheimer's disease.
• Elevated CSF tau with normal phosphorylated tau (p-tau) is typically indicative of aggressive neurological diseases, such as CJD.

Observation:

• A case study involving a woman with symptoms mimicking CJD, including confusion and gait ataxia.
• The patient exhibited highly elevated CSF tau and normal p-tau levels, initially suggesting an aggressive neurological condition.
• Clinical presentation and CSF biomarkers raised suspicion for CJD.

Findings:

• Immediate thiamine treatment resulted in significant clinical improvement.
• The patient recovered well within 2.5 months, indicating a reversible condition.
• The case demonstrates WE presenting with biomarker profiles typically associated with CJD.

Implications:

• This case underscores the importance of considering treatable conditions like Wernicke encephalopathy in the differential diagnosis of rapidly progressive dementia.
• Clinicians should maintain a high index of suspicion for WE, even when CSF tau levels are markedly elevated.
• Early recognition and treatment of WE are crucial for favorable patient outcomes, preventing misdiagnosis as incurable neurodegenerative diseases.