Acute hearing and visual loss caused by thiamine deficiency

Area of Science:

• Neurology
• Nutritional Neuroscience

Background:

• Wernicke encephalopathy (WE) is a neurological emergency caused by thiamine deficiency.
• Classic WE symptoms include ocular signs, ataxia, and confusion; sensory loss is less common.
• This case involves a non-alcoholic liver cirrhosis patient with chronic hepatitis C.

Observation:

• A 60-year-old man presented with acute bilateral blindness and hypoacusis.
• Initial ophthalmologic and otologic exams revealed no abnormalities.
• Neuroimaging showed characteristic symmetric FLAIR hyperintensities in the thalamus, periventricular region, and medulla.

Findings:

• Diagnosis of Wernicke encephalopathy was confirmed based on clinical presentation and MRI findings.
• The patient developed a mild coma post-admission.
• Rapid improvement in consciousness, vision, and hearing occurred after thiamine administration.

Implications:

• Wernicke encephalopathy should be considered in patients with unexplained sudden vision and hearing loss.
• This case expands the known clinical spectrum of Wernicke encephalopathy presentations.
• Prompt thiamine supplementation is crucial for reversing neurological deficits in WE.