Young Nonalcoholic Wernicke Encephalopathy Patient Achieves Remission Following Prolonged Thiamine Treatment and Cognitive Rehabilitation

Abstract

Wernicke encephalopathy (WE), a neurological emergency commonly associated with alcohol use disorder, results from a severe deficiency of vitamin B1. If left untreated, patients either succumb to the illness or develop chronic Korsakoff’s syndrome (KS). Recently, an increasing number of nonalcoholic WE case studies have been published, highlighting a lack of understanding of malnutrition-related disorders among high-functioning patients. We present the case of a 26 year old female who developed life-threatening WE after COVID-19-complicated obesity surgery. She experienced the full triad of WE symptoms, including eye-movement disorders, delirium, and ataxia, and suffered for over 70 days before receiving her initial WE diagnosis. Late treatment resulted in progression of WE symptoms. Despite the severity, the patient achieved remission of some of the symptoms in the post-acute phase due to prolonged parenteral thiamine injections and intensive specialized rehabilitation designed for young traumatic brain injury (TBI) patients. The rehabilitation resulted in gradual remission of amnesia symptomatology, mainly increasing her autonomy. The late recognition of this case highlights the importance of early diagnosis and prompt, targeted intervention in the management of nonalcoholic WE, as well as underscores the potential for positive outcomes after delayed treatment through intensive cognitive rehabilitation in specialized treatment centers.

Observations on the Clinical Features of the Wernicke–Korsakoff Syndrome

“…However, these non-alcoholic patients are less susceptible to chronic confusion [35] and prolonged cognitive deficits than alcoholics, which Kopelman [31] attributed to generally higher standards of premorbid nourishment, and very likely more prompt treatment. Consistent with this, Oudman et al [57] reported an excellent outcome in a Wernicke case following bariatric surgery, complicated by COVID-19, in whom high-dose thiamine intravenous treatment was delayed but then administered for over 2 months.…”

Case report: Wernicke–Korsakoff syndrome after bariatric surgery

“…WE is a neurological syndrome caused by thiamine deficiency (9). It is more common in alcoholics, although any disease that causes malnutrition and thiamine deficiency can give rise to the syndrome (13,14); for example, cancer patients, gastrointestinal diseases, or gastrointestinal tract surgery lead to a reduction in nutrient intake and absorption (3). Cases of WE following BS have been described for at least 40 years (3).…”

“…Although there is no consensus on the dosage, frequency, and duration of thiamine administration in the treatment of WE (21), it should be noted that the duration of treatment and the dosage administered were lower than the existing recommendations. Oudman et al, defend that cognitive and motor outcomes are better in groups that receive more than 500 mg/ day as an initial dose (14). Additionally, it highlights that longer treatment and higher doses are likely to result in more favorable outcomes (14).…”

“…Oudman et al, defend that cognitive and motor outcomes are better in groups that receive more than 500 mg/ day as an initial dose (14). Additionally, it highlights that longer treatment and higher doses are likely to result in more favorable outcomes (14). According to Infante et al, high doses of intramuscular thiamine for a longer period, with gradual dose reduction after clinical parameters improve, and maintenance of intramuscular thiamine at 200 mg/day for at least 12 months should be employed (21).…”