Korean J Pediatr.  2014 Nov;57(11):496-499. 10.3345/kjp.2014.57.11.496.

Wernicke's encephalopathy in a child with high dose thiamine therapy

• Park SW
• Yi YY
• Han JW
• Kim HD
• Lee JS
• Kang HC

• KMID: 2284138
• DOI: http://doi.org/10.3345/kjp.2014.57.11.496

Abstract

Wernicke's encephalopathy is an acute neurological disorder characterized by mental confusion, oculomotor dysfunction, and ataxia. It has been reported in individuals with alcohol dependence, hyperemesis gravidarum, and prolonged parenteral nutrition without vitamin supplementation. Here we present the case of a 13-year-old male patient with neuroblastoma and a history of poor oral intake and nausea for 3 months. After admission, he showed gait disturbances, nystagmus, and excessive dizziness; his mental state, however, indicated he was alert, which did not fit the classical triad of Wernicke's encephalopathy. A diagnosis of Wernicke's encephalopathy was made only after brain magnetic resonance imaging and serum thiamine level analyses were performed. The patient's symptoms remained after 5 days of treatment with 100-mg thiamine once daily; thus, we increased the dosage to 500 mg 3 times daily, 1,500 mg per day. His symptoms then improved after 20 days of replacement therapy. This case report describes a pediatric patient who was promptly diagnosed with Wernicke's encephalopathy, despite only 2 suspicious symptoms, and who completely recovered after high doses of thiamine were given intravenously.

Keyword

Wernicke encephalopathy; Thiamine deficiency; Parenteral nutrition

MeSH Terms

Adolescent
Alcoholism
Ataxia
Brain
Child*
Diagnosis
Dizziness
Female
Gait
Humans
Hyperemesis Gravidarum
Magnetic Resonance Imaging
Male
Nausea
Nervous System Diseases
Neuroblastoma
Parenteral Nutrition
Pregnancy
Thiamine Deficiency
Thiamine*
Vitamins
Wernicke Encephalopathy*
Thiamine
Vitamins