Coma and hypothermia in Wernicke's encephalopathy

Area of Science:

• Neurology
• Endocrinology

Background:

• Wernicke's Encephalopathy (WE) is a serious neurological complication often associated with chronic alcoholism.
• Hypothermia can be a presenting symptom in severe neurological conditions, including WE.
• Thiamine deficiency is the primary cause of Wernicke's Encephalopathy.

Observation:

• Two patients with Wernicke's Encephalopathy and subsequent hypothermia were treated with thiamine.
• Both patients showed rapid improvement following thiamine administration.
• One patient underwent hypothalamic-pituitary function testing, revealing abnormal responses to TRH and hypoglycemia.

Findings:

• The patient exhibited a depressed TSH response to TRH and a sluggish cortisol response to hypoglycemia.
• These neuroendocrine abnormalities suggest potential hypothalamic damage.
• Findings support the hypothesis that thiamine deficiency may mediate hypothalamic-pituitary dysfunction in chronic alcoholics.

Implications:

• Thiamine deficiency may be a key factor in the hypothalamic-pituitary abnormalities observed in chronic alcoholics.
• Hypothalamic damage due to thiamine deficiency could contribute to hypothermia in Wernicke's Encephalopathy.
• Intravenous thiamine administration is crucial for managing coma of unknown etiology, especially in suspected WE cases.