Acute delirium in a critically ill patient may be a wolf in sheep's clothing

Area of Science:

• Critical Care Medicine
• Neuroscience
• Internal Medicine

Background:

• Acute delirium is common in intensive care units (ICUs), often leading to poor patient outcomes.
• Causes of delirium are diverse, and misdiagnosis can prolong critical illness.
• Alcoholic patients in the ICU are particularly vulnerable to specific neurological complications.

Purpose of the Study:

• To highlight the critical importance of recognizing Wernicke's encephalopathy in critically ill alcoholic patients.
• To emphasize the potential for misdiagnosis of this condition as standard ICU delirium or withdrawal syndromes.
• To advocate for systematic thiamine administration in at-risk populations.

Main Methods:

• Case report of a critically ill alcoholic patient with prolonged ICU delirium.
• Clinical presentation including protracted vomiting, swallowing disorders, and aspiration.
• Diagnostic confirmation via neurological signs (nystagmus, ophthalmoplegia) and cerebral MRI.

Main Results:

• The patient's prolonged delirium was initially misdiagnosed as sedation and alcohol withdrawal.
• Neurological signs and MRI confirmed Wernicke's encephalopathy.
• Thiamine supplementation led to clinical improvement, though discharge was delayed.

Conclusions:

• Wernicke's encephalopathy is an underdiagnosed, acute, and reversible neuropsychiatric emergency in critically ill alcoholic patients.
• Systematic thiamine supplementation is crucial for all critically ill alcoholic patients, especially those with vomiting.
• Early recognition and treatment are vital to prevent prolonged morbidity.