A Summertime Stupor

Area of Science:

• Neurology
• Internal Medicine
• Nutritional Science

Background:

• Wernicke's encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency.
• It is commonly associated with alcohol use disorder in developed nations.
• Malnutrition is the leading global cause of WE, often overlooked in diverse clinical settings.

Observation:

• A case of a 21-year-old female presenting with acute decline in consciousness and severe hypothermia is described.
• The patient exhibited clinical and imaging findings consistent with WE.
• These symptoms occurred in the context of pancreatitis and chronic gastritis.

Findings:

• The case highlights that WE can manifest in patients with conditions predisposing to malnutrition, even with normal or high BMI.
• Altered mental status (AMS) in at-risk individuals warrants strong suspicion for WE.
• Diagnostic challenges arise when WE coexists with other gastrointestinal or systemic conditions.

Implications:

• Prompt diagnosis and initiation of thiamine therapy are critical for preventing irreversible neurological deficits.
• Clinicians should consider WE in patients with AMS and risk factors for malnutrition, irrespective of nutritional status indicators.
• This case underscores the importance of recognizing WE beyond its typical association with alcoholism.