A0026 Diagnosis of Nonalcoholic Wernicke Encephalopathy in an Intensive Care Unit Patient: A Diagnostic Dilemma

Sonika Bishnoi, Satinder Gombar, Vanita Ahuja, Vinod Bishno
2019 20th Annual Conference of Indian Society of Neuroanaesthesiology and Critical Care (ISNACC)   unpublished
nonrefractory status epilepticus. When RSE occurs in an individual without any history of epilepsy and no immediate underlying etiology is found, it is referred to as new-onset refractory status epilepticus (NORSE). This clinical scenario may be notoriously difficult to treat and does not respond to initial medications. In cases of NORSE where an etiology is found, antibody-mediated disorders are the most common cause. Autoimmune encephalitis refers to a diverse group of neuropsychiatric
more » ... opsychiatric disorders. It can have a variable pattern of clinical presentation with an array of symptoms many of which make diagnosis difficult due to similarities in clinical, imaging, and laboratory findings with respect to other forms of autoimmune or infectious encephalitis. Case Description: Our case report highlights how a patient with acute-onset history, showing generalized periodic epileptiform discharges on electroencephalogram (EEG) but with no prior history of seizures was eventually diagnosed as autoimmune encephalitis based on clinical findings, cerebrospinal fluid (CSF) reports, and EEG analysis. Conclusions: As a presentation of autoimmune encephalitis, nonconvulsive status epilepticus requires high level of suspicion. Early EEGs with prompt and aggressive treatment can improve patient outcomes drastically. Background: Wernicke encephalopathy (WE) is a known complication of thiamine deficiency, normally seen in patients having excessive alcohol intake. It is characterized by a triad of symptoms of confusion, ophthalmoplegia, and ataxia. Symptomatic thiamine deficiency in nonalcoholics is less known (0.1%) and is often underdiagnosed. Overall, if WE is diagnosed at an early stage and treated, complications can be reversed. We present the case of a patient operated for perforation peritonitis who was subsequently diagnosed and managed for nonalcoholic WE. Case Description: A 22-year-old male patient admitted to surgical emergency with complain of pain abdomen and vomiting since 2 days survived after an event of cardiac arrest. Patient was operated for perforation peritonitis and shifted to intensive care unit (ICU). On 35th day of ICU stay, he became disoriented and developed nystagmus. A provisional diagnosis of neurological sequelae of hypoxic ischemic brain injury was made, and MRI was planned. MRI showed features suggestive of WE. Intravenous thiamine was started. Background: Nonconvulsive status epilepticus (NCSE) accounts for 25% of all cases of status epilepticus. Refractory status epilepticus (RSE) is defined as continued clinical/electrographic seizures after adequate dosing of initial benzodiazepine, followed by second-line antiepileptic drug and is associated with worse prognosis than
doi:10.1055/s-0039-1684133 fatcat:mxkcg625xnc4ljwm2gghkc2lwu