Wernicke encephalopathy and beriberi disease presenting as STEMI-equivalent

Area of Science:

• Neurology
• Cardiology
• Nutritional Science

Background:

• Thiamine deficiency is linked to malnutrition, alcoholism, and bariatric surgery.
• It can present as peripheral neuropathy, Wernicke encephalopathy, or beriberi disease.

Observation:

• A 72-year-old male with a hiatal hernia developed thiamine deficiency secondary to malnutrition.
• Initial symptoms mimicked a myocardial infarct with characteristic ECG changes (shark-fin evolving to Wellens type B).
• The patient subsequently presented with severe altered mental status.

Findings:

• Wernicke encephalopathy was diagnosed via MRI.
• High-dose thiamine administration resulted in swift neurological and cardiac recovery.
• The clinical presentation and treatment response confirmed co-existing Wernicke encephalopathy and beriberi disease.

Implications:

• This case highlights the diverse and potentially cardiac-mimicking presentations of thiamine deficiency.
• Early diagnosis and aggressive thiamine repletion are crucial for favorable outcomes in Wernicke encephalopathy and beriberi.
• Awareness of nutritional deficiencies is vital in managing patients with gastrointestinal issues and altered mental status.