Wernicke Encephalopathy in a 15-Year-Old Girl: A Case

Andrew N. Wilner, MD

Disclosures

June 05, 2018

Introduction

While attending the 2018 American Academy of Neurology (AAN) meeting in Los Angeles, California, Medscape contributor Andrew N. Wilner, MD, interviewed Ariel Lyons-Warren, MD, PhD, about her case report of a teenager with pediatric Wernicke encephalopathy.[1] Dr Lyons-Warren is a pediatric neurology resident at Baylor College of Medicine and Texas Children's Hospital in Houston.

Andrew N. Wilner, MD: I just saw a young pregnant woman on our inpatient service who had hyperemesis gravidarum and developed Wernicke encephalopathy, so your AAN Resident Poster on that topic interested me. I see you have MRI scans with the typical findings. Could you describe those findings?

Ariel Lyons-Warren, MD, PhD: The typical MRI findings in Wernicke encephalopathy in children and adults include a T2 FLAIR hyperintensity—brightness on the T2-weighted MRI in the bilateral medial thalami and the periaqueductal region. The mammillary bodies also can be involved.

Wilner: I'm an adult neurologist so I was intrigued: Why would a child have Wernicke encephalopathy?

Lyons-Warren: Wernicke encephalopathy is actually believed to be just as prevalent in children as in adults and, as in adults, it is underdiagnosed. Our patient, a 15-year-old girl, developed Wernicke encephalopathy because she had undergone a Roux-en-Y gastric bypass, which is a common risk factor for Wernicke encephalopathy. She was not taking her vitamins and became vitamin deficient.

Wilner: What clued you in to the diagnosis?

Lyons-Warren: I was moonlighting in the pediatric ICU when this patient came to us. Her only symptom was an isolated ophthalmoplegia and we didn't know why. Her history of Roux-en-Y gastric bypass made me think about a vitamin deficiency. But the classic triad of Wernicke encephalopathy is altered mental status, ophthalmoplegia, and ataxia, and she did not have the other two symptoms. So it wasn't first on our diagnostic list, but we ordered the MRI and saw the typical findings.

Wilner: Were you able to get a thiamine level (vitamin B1) to document the deficiency?

Lyons-Warren: The team checked the thiamine level the next day. The results came back a few days later at 26 nmol/L, which is very low.

Wilner: I imagine you gave this unfortunate 15-year-old some thiamine. Did it help?

Lyons-Warren: Yes. She is completely back to baseline. My coauthor, Dr Danielle Takacs, sees her in clinic, and other than continuing to be noncompliant, she's completely back to herself.

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