An Unusual Presentation of Catatonia in Non-alcoholic Wernicke Encephalopathy

Abstract

Wernicke encephalopathy (WE) is an acute reaction to thiamine deficiency, which presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. However, thiamine deficiency can also present with several neuropsychiatric signs and symptoms other than the classical triad. We report a patient who presented with catatonia as a presenting feature of WE. The objective of this report is to recognize the presentation of catatonia in WE. Some cases of WE are missed by physicians; therefore, a high index of suspicion and appropriate investigations depending on presentation and clinical condition can result in prompt diagnosis and early management.

Wernicke's encephalopathy in adolescents with anorexia nervosa

“…Excited catatonia, a disorder characterized by purposeless and excessive motor activity that may include confusion and/or confabulation, has been described in the literature with AN ( Wolańczyk et al, 1997 ). WE has also been described in patients with AN ( Ahmed et al, 2021 ). Catatonia could have been tested using a lorazepam trial: giving 1-2 mg lorazepam enterally once and assessing change in behavior; however, this was felt unlikely as patient had previously demonstrated marked sedation with low dose lorazepam and showed marked improvement with treatment of thiamine and olanzapine.…”

Clinical evaluation and management of a 45-year-old man with confusion, psychosis, agitation, stereotyped behavior, and impaired speech

“…(2) Mr. A had frequent foot infections and had several surgeries for his back and feet. Frequent infections and surgeries may contribute to thiamine deficiency and subsequently cause Wernicke-Korsakoff syndrome [ 5 – 7 ]. (3) Mr. A's body mass index was 19.5 which was within normal range, but he was dependent on “junk food” for years due to his difficulty ambulating and poor self-care.…”

“…(3) Mr. A's body mass index was 19.5 which was within normal range, but he was dependent on “junk food” for years due to his difficulty ambulating and poor self-care. Malnutrition was reasonably suspected in Mr. A's case and can be an exacerbating factor for Wernicke-Korsakoff syndrome, as malnutrition alone can cause Wernicke-Korsakoff syndrome [ 5 , 7 , 11 ]. (4) Mr. A had not received any IV thiamine or high dose PO thiamine prior to his admission to UMMC.…”

Exploring a Multidisciplinary Approach to Wernicke's Encephalopathy in Pregnancy

“…Although uncommon, catatonia may be present in WE. 39 After discussion of the risks and benefits of a benzodiazepine trial with the patient's mother/ health care proxy, an empiric benzodiazepine challenge was attempted with diazepam 20 mg IV. The trial ultimately failed as it caused somnolence without improvement in her Bush-Francis score.…”

“…In November 2022, the patient’s initial score on the Bush-Francis Catatonia Rating Scale was 10. Although uncommon, catatonia may be present in WE 39 . After discussion of the risks and benefits of a benzodiazepine trial with the patient’s mother/health care proxy, an empiric benzodiazepine challenge was attempted with diazepam 20 mg IV.…”