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Washington University Experience | METABOLIC | Wernicke Encephalopathy | 4A0 Case 4 History
Case 4 History ---- The patient was a 58 year old woman with a past medical history significant for hypertension, alcohol abuse, and end stage renal disease requiring hemodialysis. She was admitted to an outside hospital with abdominal pain and was found to have pancreatitis and gallstones. She subsequently developed altered mental status with blood pressure of 220/146 followed by seizure-like activity which reoccurred every 7 minutes and resolved completely with Versed. She was then started on antibiotics and antivirals empirically, as well as Keppra, Dilantin, and Versed for seizure activity. A brain MRI showed global cerebral injury and she was thereafter given only comfort care and expired.
Postmortem examination showed acute global hypoxic-ischemic damage ranging from selective neuronal necrosis to infarction involving the neocortex, hippocampus, basal ganglia, thalamus and midbrain. In addition she had hepatic encephalopathy from alcoholic liver damage and Wernicke encephalopathy.
