CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 January-February;178(1-2):78-83

DOI: 10.23736/S0393-3660.17.03700-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Wernicke’s encephalopathy in a subject with enter-colic fistula

Daniele CANOVA ¹ ✉, Paola SCALON ¹, Fabio MONICA ², Stefano A. GRASSI ¹, Anna GIACOMIN ¹, Tiziana TUMELERO ¹, Gaetano MASTROPAOLO ¹, Francesco MALFA ³

¹ Unit of Gastroenterology, San Bassiano Hospital - ULSS 7, Bassano del Grappa, Vicenza, Italy; ² Unit of Gastroenterology, Cattinara Hospital, University of Trieste, Trieste, Italy; ³ Unit of Neurology, S. Maria del Prato Hospital, Feltre, Belluno, Italy

Wernicke’s encephalopathy is an acute neuro-psychiatric condition caused by deficit of thiamine requiring an urgent diagnosis and a prompt treatment to prevent chronic neurological damage or even death. It is more frequently associated to alcohol misuse but can also arise in subjects with signs and symptoms of malnutrition or suffering from different disturbances with reduced intake or absorption of vitamin B1 or its increased loss. The diagnosis is mainly clinical and a cerebral magnetic resonance imaging is useful to support the medical suspicion. The classical triad of symptoms (mental confusion, ophthalmoplegia and gain ataxia) is present in few patients while many present only with a confusional mental state. We reported here a case of a 50-year old man suffering of an enter-colic fistula admitted at our Unit because of worsening diarrhea and vomiting with signs of malnutrition who developed Wernicke’s encephalopathy. Only a prompt diagnosis and thiamine replacement avoided neurological permanent sequela. Therefore in all patients with suspected thiamine deficiency, the onset of mental disturbances has to lead doctors to rapidly suspect the syndrome and consequently administrate parenteral high-dose of thiamine. Moreover in all subjects with suspected thiamine deficiency, prophylactic administration of thiamine can prevent the development of Wernicke’s encephalopathy.

KEY WORDS: Malnutrition - Wernicke encephalopathy - Intestinal fistula