Wernicke's encephalopathy after cardiac surgery.

Area of Science:

• Neurology
• Cardiology
• Nephrology

Background:

• A 76-year-old woman on long-term hemodialysis underwent cardiac surgery for valvular insufficiency and atrial fibrillation.
• Patients with chronic kidney disease and those undergoing major surgery are at increased risk for various complications.

Observation:

• Postoperatively, the patient exhibited sudden neurological deficits including altered consciousness, aphasia, and limb ataxia.
• Initial brain imaging (CT and MRI) failed to reveal structural abnormalities.
• Clinical presentation suggested a metabolic encephalopathy, specifically Wernicke's encephalopathy.

Findings:

• Administration of vitamin B1 (thiamine) led to a gradual but complete resolution of neurological symptoms.
• This rapid improvement confirmed the diagnosis of Wernicke's encephalopathy.
• The patient was discharged neurologically asymptomatic on postoperative day 42.

Implications:

• Highlights the importance of considering Wernicke's encephalopathy in hemodialysis patients presenting with neurological disturbances post-surgery.
• Emphasizes the critical role of timely thiamine supplementation in managing and reversing these potentially devastating neurological complications.
• Suggests that subclinical thiamine deficiency may be more prevalent in hemodialysis patients undergoing significant physiological stress.