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Washington University Experience | METABOLIC | Wernicke Encephalopathy | 5A0 Case 5 History
Case 5 History ---- The patient was a 35 year old HIV-positive man treated in the past for Pneumocystis carinii pneumonia, syphilis and oral herpes simplex. He presented to the ER with mental status change (disorientation) and low grade fever for 3-4 days. The patient was unable to talk in coherent manner but responded to simple commands, withdrew to pain, and moved all four extremities synchronously. The differential diagnosis included meningitis, HSV-I encephalitis and PML. He had elevated serum amylase and lipase, consistent with pancreatitis. His mental status seemed to improve initially but became progressively worse with superimposed seizure activity, minimal response to painful stimuli, right hemiparesis, left gaze, and minimal reactive pupils. Head CT scan on 6/9/98 demonstrated diffuse brain edema. The family decided to provide comfort measures only and the patient expired.
Neuroautopsy demonstrated hepatic encephalopathy, petechial hemorrhage, astrocytosis and capillary proliferation involving the MB, thalamus and periventricular portions of the midbrain, pons, and medulla. The patient was a social drinker and never carried a diagnosis of alcoholism. Case reports have described the pathological changes of Wernicke disease in significant numbers of AIDS patients, including patients without a clinical history of alcoholism.
