Non-Alcoholic Wernicke-Korsakoff Syndrome Following Restrictive Diet and Prolonged Vomiting in a Young Woman: A Case Report

Wernicke-Korsakoff syndrome (WKS) is a neurological disorder resulting from severe thiamine deficiency and is classically associated with chronic alcohol use. Non-alcoholic causes, though less well recognised, include prolonged vomiting, restrictive dietary intake, and other malnourished states. We report a 25-year-old woman with no history of alcohol consumption who presented with a two-day history of confusion, unsteadiness, and horizontal diplopia, together with an inability to recognise close family members, following three weeks of poor oral intake and recurrent vomiting associated with a restrictive diet. Examination revealed disorientation, confabulation, profound anterograde amnesia, horizontal nystagmus, and a broad-based gait. Magnetic resonance imaging demonstrated changes consistent with Wernicke encephalopathy, and serum thiamine was low. She was treated with high-dose intravenous thiamine prior to glucose administration, along with supportive care. Nystagmus and gait ataxia improved, but the amnestic deficit and confabulation persisted at discharge. This case underscores that thiamine depletion from restrictive eating and prolonged vomiting alone, independent of alcohol use, can precipitate the full Wernicke-Korsakoff triad in young women, and highlights the need for a high index of suspicion and prompt thiamine replacement to prevent irreversible neurological sequelae.