Case history
Case history #1
A 40-year-old man with a history of alcohol-use disorder is brought to the emergency department by police, who found him lying down by the side of the street. On examination he is somnolent and confused. He has a horizontal gaze palsy with impaired vestibulo-ocular reflexes and severe gait ataxia in the presence of normal motor strength and muscle stretch reflexes.
Case history #2
A 30-year-old woman underwent bariatric surgery for class 3 (BMI ≥40 kg/m²) obesity. The post-operative course was complicated by pneumonia, vomiting, and poor oral intake. Four weeks after surgery she complained of vertigo and headache and soon became apathetic and developed vertical nystagmus that was worse on downward gaze.
Other presentations
Hospitalised patients have multiple risk factors for thiamine deficiency including poor nutritional intake, increased metabolic demand, resuscitation with glucose-containing fluids, and medical conditions that may impair thiamine absorption from dietary sources.[5][6]
Pregnant women who experience hyperemesis gravidarum have a higher metabolic demand and are therefore more susceptible to thiamine deficiency Wernicke's encephalopathy.[7][8]
Patients receiving parenteral nutrition, which may not include sufficient supplemental thiamine, are at risk.[9][10]
Patients with psychiatric diseases, including restrictive eating patterns (e.g., anorexia nervosa), are also vulnerable.[11][12][13]
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