Wernicke encephalopathy presenting as a stroke mimic: A case report

Several conditions may present with acute neurological symptoms, thus mimicking the presentation of stroke. Although the underlying disorder can be diagnosed after careful medical, neurological, and radiological examinations, a few conditions, such as Wernicke encephalopathy (WE), may present a particular diagnostic difficulty. WE is a neurological disorder caused by deficiency of thiamine (B1 vitamin), most often resulting from alcoholism, malnutrition, hyperemesis gravidarum or bariatric surgery. The diagnosis of WE in a certain historical, clinical setting is easily suggested, but in a few cases presenting with acute neurological deficits, it can be particularly challenging.

We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities, dizziness and a confusional state, which had lasted for approximately 30 minutes. The patient had a similar episode of a confusional state approximately two months earlier; at that time, a transient ischemic attack was suspected and he was started on aspirin. The initial clinical evaluation and imaging findings were unremarkable for stroke, but the patient's symptoms, history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE. Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis.

Through this case report, we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke, especially when the presentation is atypical or when risk factors for thiamine deficiency are present. Since intravenous thiamine significantly improves outcomes, delayed recognition and treatment in some cases might be deleterious.