Abstract Details

Title Wernicke's Encephalopathy Manifesting as WEBINO after Acute Pancreatitis

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 225

Objective

Background BACKGROUND: Wernicke's encephalopathy is a well-recognized metabolic disorder of central nervous system. A subset of patients develop WE after acute pancreatitis, usually during the recovery phase. The reasons remain ill-defined.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 18 year old man with cognitive impairment since childhood developed abdominal pain, mild fever, intractable nausea, vomiting and diarrhea. He was admitted to the ICU with hypovolemic shock and required aggressive fluid resuscitation. Lipase was greater than 1000 IU/L and abdominal CT scan identified plump pancreas with no other sign of acute pancreatitis. Acute viral pancreatitis was diagnosed. One month later, outward deviation of both eyes and behavioral changes with agitation were noted. Neurologic examination revealed baseline cognitive impairment, mild agitation and bilateral INO, referred to as WEBINO, without any other overt neurologic deficits. Brain MRI showed restricted diffusion within the bilateral globus pallidus, putamen and caudate heads. T2 hyperintense signal was seen within the globus pallidi, putamen, caudate head, midline of the pons, mammillary bodies and periaqueductal area. Post-contrast images demonstrated patchy enhancement in all areas of T2 signal abnormality. MR Spectroscopy revealed non-specific findings. Routine serology, B12 and Folate levels were normal. A diagnosis of WE was made. He was treated with IV Thiamine followed by oral replacement. He continued to have bilateral INO and was subsequently lost to follow up.

Conclusions CONCLUSIONS: WE manifesting with WEBINO can develop fairly rapidly, even in previously healthy persons, in the recovery phase after acute diarrhea and pancreatitis. MRI is essential in making the diagnosis. Whether prophylactic treatment with thiamine should be given to all patients with acute pancreatitis remains unclear and warrants further investigation.

Authors/Disclosures
Vivek Rai, MD PRESENTER	Dr. Rai has nothing to disclose.
	No disclosure on file
Panayiotis Mitsias, MD (Henry Ford Hospital, Neurology)	The institution of Dr. Mitsias has received research support from European Union.
Alastair Compston, PhD, FRCP	No disclosure on file

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