I can’t hear you, you said I had what?: A case report and literature review

Abstract

We report the case of a 46-year old African American woman who presented to the emergency department with one week of progressive bilateral deafness associated with worsening gait abnormalities, visual changes, and confusion. She was diagnosed with Wernicke encephalopathy (WE) attributed to alcohol abuse; her symptoms, including hearing loss, improved with thiamine replacement. WE, a condition due to thiamine deficiency, commonly affects those with alcohol use disorder or gastric bypass history. Though traditionally associated with a triad of encephalopathy, ophthalmoplegia, and ataxia, it can be more rarely associated with auditory deficits or other neurologic findings. Though hearing loss has previously been reported as a rare symptom of WE, it has not been described in WE due to alcohol abuse. We performed a review of the literature to determine if WE associated with hearing loss had been previously reported.

A Case of Sensorineural Hearing Loss in Wernicke Encephalopathy

“…Ton et al presented the most recent review of cases of SNHL in WE, which only highlighted one case in which alcohol contributed to the patient's thiamine deficiency 1 . A further literature search has only yielded one other similar case of alcohol‐related thiamine deficiency 3 . We present the third known case of hearing loss in WE related to alcoholism.…”

“…1 A further literature search has only yielded one other similar case of alcoholrelated thiamine deficiency. 3 We present the third known case of hearing loss in WE related to alcoholism. Further research is needed to better understand why alcohol represents such a small portion of these cases despite being the most common cause of WE.…”

Acute bilateral deafness and bilateral blindness in a patient with liver cirrhosis

“…Magnetic resonant imaging (MRI) is a reliable test for WE. The reported sensitivity and speci city of MRI for diagnosisof WE are 53% and 93%, respectively [5]. Increased T2-weighted and uid-attenuated inversion recovery (FLAIR) signal intensities in the regions of the periaqueduct, periventricle, and medial thalami are the characteristic features [2].This patient showed typical MRI ndings of symmetric FLAIR hyperintensities in the brain stem, medulla oblongata, bilateral dorsal thalamus, and periventricular region of the third ventricle.…”

Acute hearing and visual loss caused by thiamine deficiency

“…MRI is a reliable test for WE. The reported sensitivity and specificity of MRI for the diagnosis of WE are 53% and 93%, respectively [ 14 ]. Increased T2-weighted and FLAIR signal intensities in the periaqueduct, periventricular, and medial thalami regions are the characteristic features [ 5 ].…”

“…In this patient, DWI restriction was observed in the medial and lateral geniculate bodies, indicating impairment of the visual and auditory pathways. Some studies have demonstrated that MRI has a high specificity but low sensitivity for WE [ 14 , 16 ]. However, a large number of researchers believe that MRI is a powerful and reliable tool that should be used to support the diagnosis of acute WE in both alcoholic and and nonalcoholic individuals [ 5 , 17 , 18 ].…”