A Simple Restriction, a Complex Collapse: Multisystem Wernicke Encephalopathy Triggered by Self-Starvation

Wernicke encephalopathy (WE) is an acute neuropsychiatric emergency caused by thiamine deficiency, most commonly associated with chronic alcoholism but increasingly recognized in non-alcoholic contexts. This report describes a 23-year-old woman who developed WE secondary to prolonged self-imposed starvation driven by distorted body image. She had deliberately restricted food intake for several weeks, believing she was overweight, which led to severe malnutrition, weight loss, and profound weakness. On admission, she presented with bilateral ptosis, nystagmus, and lower limb weakness but without overt confusion. Laboratory evaluation revealed severe normocytic anemia, hypoalbuminemia, hypophosphatemia, hypomagnesemia, and critically low vitamin D levels. Magnetic resonance imaging of the brain demonstrated symmetric hyperintense lesions in the medial thalamus and periaqueductal gray matter, findings characteristic of WE. High-dose intramuscular thiamine was initiated immediately, alongside electrolyte correction, nutritional rehabilitation, and transfusion for anemia. The patient's neurological symptoms and biochemical abnormalities improved steadily, and she was discharged in stable condition after nine days of hospitalization. This case underscores that WE can occur in young, non-alcoholic individuals with self-starvation or restrictive eating behaviors, even in the absence of a diagnosed eating disorder. The presentation may be incomplete and easily overlooked, emphasizing the importance of maintaining clinical suspicion in any malnourished or vomiting patient. Early administration of thiamine remains the cornerstone of treatment and can lead to full neurological recovery when implemented promptly. This case further highlights the need for heightened awareness of nutritional brain injury associated with modern body-image distortion and restrictive dieting practices among young adults.