An atypical presentation of Wernicke's encephalopathy in an 11-year-old child

A Case Report of Wernicke’s Encephalopathy in a Pediatric Patient with Anorexia Nervosa - Restricting Type

“…Since this publication, 16 additional cases of pediatric Wernicke's encephalopathy have been reported. None of these patients was diagnosed with anorexia nervosa [21][22][23][24][25][26][27][28]. We believe that is the first reported case of Wernicke's encephalopathy in an adolescent patient with anorexia nervosa.…”

Atypical Wernicke′s syndrome sans encephalopathy with acute bilateral vision loss due to post-chiasmatic optic tract edema

“…The presentation of acute vision loss in association with other features of WE has been published in literature before, but in those cases vision loss has been related to the optic disc edema or retinal dysfunction due to intra retinal hemorrhage as a cause of vision loss, which could be related to alcohol toxicity or as a part of WE manifestations. [4513] Our patient had normal fundoscopy, normal pupillary light reflex; thus ruling out optic disc, optic nerve or retinal abnormality as a cause of vision loss and so our patient's presentation with visual loss due to post-chiasmatic bilateral optic tract involvement is quite unique in comparison to other described cases.…”

“…[136] A high index of suspicion for non-alcohol related WE is required in patients with prolonged fasting, parenteral nutrition, long-term intravenous glucose infusion like patients with corrosive ingestion or hyperemesis gravidarum. [234] Apart from these, WE can also occur after gastrointestinal surgical procedures carried out for cancer or obesity surgery, including gastro-jejunostomy, total or partial gastrectomy, gastric bypass surgery. [2378] In patients with gastric surgery, WE is reported to develop usually weeks or months after the operation.…”

“…There are only few reports in the literature describing acute vision loss as a presenting feature of Wernicke's syndrome, with variable neuro-anatomic abnormality as a cause of blindness. [45] We describe a patient presenting with acute vision loss in the clinical setting of WE without the classical triad and with rare imaging findings and improvement with thiamine supplementation.…”

Optic Neuropathies Caused by Micronutrient Deficiencies and Toxins

“…16 prolonged vomiting, 17 intense physical activity, admission to an emergency room, 18 and rarely ingestion of food contaminated by thiaminases. There are no systemic stores of thiamine in humans; therefore, thiamine depletion occurs within a few weeks of dietary deprivation.…”