Thyrotoxicosis With Development of Wernicke Encephalopathy in an Adolescent

ABSTRACT Objective: Wernicke encephalopathy (WE) is a rare disorder resulting from deficiency of thiamine (vitamin B1). It is precipitated by conditions including thyrotoxicosis, hyperemesis gravidarum, and alcoholism. The disease is not always suspected in pediatric patients, and its presentation can be atypical, so it is often underdiagnosed. Methods: We present a case of severe WE in a 13-year-old female that was precipitated by malnutrition secondary to vomiting, abdominal pain, and weight loss due to gastritis. Features of WE were induced by concomitant untreated hyperthyroidism. The patient showed the classical triad of WE clinically and had typical brain magnetic resonance imaging features. Results: Encephalopathy was dramatically improved after thiamine replacement. Her disease course ended with full reversal of neurologic deficits and radiologic abnormalities within 7 weeks. Conclusion: WE is a debilitating condition that can be life-threatening if not treated. It is underdiagnosed in children but can present with classical clinical and radiological features that should prompt the diagnosis. As with adults, untreated hyperthyroidism with a malnutrition state can lead to WE in children, and thiamine replacement can reverse the condition. Abbreviations: MRI = magnetic resonance imaging NR = normal range WE = Wernicke encephalopathy