Table of Contents
Washington University Experience | METABOLIC | Wernicke Encephalopathy | 16A0 Case 16 History (2)
Cas 16 History ---- This 20 year old man presented with exercise intolerance, cutaneous pallor and abnormal bleeding. Workup revealed acute lymphocytic leukemia. He was treated with intrathecal methotrexate and cranial irradiation. Several relapses resulted in additional radiation and addition of other chemotherapeutic drugs but, finally, developed extensor plantar reflexes, general CNS dysfunction and later died. ---- Three diagnoses were considered: hypoxic encephalopathy, Wernicke encephalopathy and acute necrosis of tumor cells in the meninges and brain parenchyma.
The findings supporting Wernicke encephalopathy included capillary proliferation of capillaries in areas which did not show hypoxic/ischemic changes (i.e., mammillary bodies, posterior hypothalamus, periaqueductal gray and nuclei in the floor of the IV ventricle in pons and medulla.
