Hypothermia Presenting in Wernicke Encephalopathy: A Case Report

Area of Science:

• Neurology
• Internal Medicine
• Endocrinology

Background:

• Wernicke encephalopathy (WE) is a serious neurologic condition often associated with thiamine deficiency.
• Hypothermia is a rare but serious complication of WE, with poorly understood mechanisms.
• Autonomic dysfunction can occur in WE, affecting thermoregulation.

Purpose of the Study:

• To report the first case of late-onset hypothermia secondary to Wernicke encephalopathy.
• To investigate the potential causes and autonomic dysfunction associated with hypothermia in this WE patient.
• To describe the management and outcome of this rare complication.

Main Methods:

• Case presentation of a 61-year-old man with a history of WE.
• Investigation of hypothermia using brain MRI, autonomic function tests (sympathetic skin response), and orthostatic hypotension assessment.
• Management included dietary modification and medication for constipation.

Main Results:

• The patient presented with hypothermia (35.0°C) after bowel preparation.
• Brain MRI showed mammillary body and hypothalamus atrophy.
• Autonomic testing revealed absent sympathetic skin responses and orthostatic hypotension.
• Conservative management resolved constipation and prevented recurrent hypothermia.

Conclusions:

• Late-onset hypothermia can be a complication of Wernicke encephalopathy, potentially related to hypothalamic and autonomic dysfunction.
• This case highlights the importance of evaluating autonomic function in WE patients presenting with temperature dysregulation.
• Conservative management was effective in resolving the hypothermia and associated constipation.