Early Signs of Thiamine Deficiency: A Case Report

Letters7 July 2020Early Signs of Thiamine Deficiency: A Case ReportJorge C. Kattah, MDJorge C. Kattah, MDUniversity of Illinois College of Medicine, Peoria, Illinois (J.C.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0836 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Recognition of early thiamine deficiency is necessary to avoid the risk for permanent neurologic deficits and early death. The Wernicke triad of encephalopathy, ataxia, and ophthalmoplegia (1) may be a late manifestation of thiamine deficiency. The Caine criteria require a history of malnutrition and 1 component of the Wernicke triad to consider the diagnosis of thiamine deficiency (2).Objective: To highlight "the earliest sign" of thiamine deficiency. Horizontal gaze–evoked nystagmus was the most common neurologic finding in large series of patients with thiamine deficiency (1, 3).Case Report: I was involved in the care of a 29-year-old woman with ...References1. Victor M, Adams RD, Collins G. The Wernicke–Korsakoff Syndrome. FA Davis. 1971. Google Scholar2. Caine D, Halliday GM, Kril JJ, et al. Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy. J Neurol Neurosurg Psychiatry. 1997;62:51-60. [PMID: 9010400] CrossrefMedlineGoogle Scholar3. De Wardener HE, Lennox B. Cerebral beriberi (Wernicke's encephalopathy); review of 52 cases in a Singapore prisoner-of-war hospital. Lancet. 1947;1:11-7. [PMID: 20278697] CrossrefMedlineGoogle Scholar4. Leigh RJ, Zee DS. The Neurology of Eye Movements. Oxford Univ Pr; 2015. Google Scholar5. Kattah JC, Dhanani SS, Pula JH, et al. Vestibular signs of thiamine deficiency during the early phase of suspected Wernicke encephalopathy. Neurol Clin Pract. 2013;3:460-468. [PMID: 30107022] doi:10.1212/01.CPJ.0000435749.32868.91 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Illinois College of Medicine, Peoria, Illinois (J.C.K.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0836. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDuodenal Adenocarcinoma in the Setting of Bariatric Surgery: A Perfect Storm for Wernicke's EncephalopathyClinical diagnosis, outcomes and treatment of thiamine deficiency in a tertiary hospitalA Case Report of Wernicke's Encephalopathy Associated With Schizophrenia Neuro-ophthalmic Manifestations of Wernicke Encephalopathy 7 July 2020Volume 173, Issue 1Page: 72-73KeywordsBrainstemCeliac diseaseLesionsMagnetic resonance imagingMigraineNeuronsNystagmusThiamineVomitingWalking ePublished: 28 April 2020 Issue Published: 7 July 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...