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Washington University Experience | METABOLIC | Wernicke Encephalopathy | 18A0 Case 18 History
Case 18 History ---- The patient was a 61yo male with a history of hypertension, hyperlipidemia, peripheral vascular disease, and anxiety/depression. In November 2020, he discontinued his home psychiatric medications and developed nausea with vomiting about three weeks later. Over the next two months he lost 80 pounds and a gastrointestinal workup showed hepatic steatosis and gastritis with a gastric ulcer. He presented to an outside hospital on January 7 after being found on the floor after an apparent fall. He developed progressive numbness, confusion, and flaccid quadriparesis with areflexia. Electroencephalography showed generalized slowing, MRI brain showed T2/FLAIR hyperintensities around the third ventricle and he received high dose thiamine but did not improve. Electromyography/nerve conduction study showed axonal sensory-motor peripheral polyneuropathy. The remainder of his course was complicated by stress cardiomyopathy with tachycardia and episodes of hypotension and hepatic ischemia. He also developed Clostridium difficile colitis. Due to ongoing poor mental status, his family decided to pursue comfort care only and he died in February 2021.
