[A case of Wernicke's encephalopathy with detrusor-sphincter dyssynergia]

We report a case of a 54-year-old man with alcoholic Wernicke's encephalopathy. Neurological examination showed unconsciousness, absence of the oculocephalic reflex, generalized hyporeflexia, and urinary retention. The patient immediately regained consciousness after the administration of thiamine, but amnesia and cerebellar ataxia became apparent. The urinary retention persisted, and an urodynamic study showed detrusor-sphincter dyssynergia. Three months after the treatment, the urinary retention resolved, and a second urodynamic study showed disappearance of the detrusor-sphincter dyssynergia. Wernicke's encephalopathy involves the periaqueductal gray matter and the floor of the fourth ventricle. For the voiding reflex, the periaqueductal gray matter neurons project to the pontine micturition center, which seems to be located adjacent to the locus coeruleus. We concluded that lesions of the periaqueductal gray matter and/or the dorsolateral portion of the pons were responsible for the micturitional disturbance in the patient.