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Gayet wernicke encephalopathy: Don’t miss this neuropsychiatric emergency!

Published online by Cambridge University Press:  13 August 2021

S. Laroussi*
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
K.S. Moalla
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
O. Hdiji
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
S. Sakka
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
S. Daoud
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
H. Hadjkacem
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
N. Farhat
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
C. Mhiri
Affiliation:
Neurology, Habib Bourguiba Hospital, sfax, Tunisia
*
*Corresponding author.

Abstract

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Introduction

Gayet Wernicke Encephalopathy (GWE) is a diagnostic and therapeutic neuropsychiatric emergency due to thiamin deficiency (vitamin B1).

Objectives

The purpose of our work is to recall some clinical situations suspecting GWE, along with radiological and evolutionary profile.

Methods

We conducted a retrospective study concerning patients who were hospitalized in the neurology department of Habib Bourguiba Hospital between 2013 and 2020 for management of GWE.

Results

The median age of 7 patients was 39.57 years with sex ratio (H/F):1.33. The most common risk factor found is incoercible vomiting (5 patients), followed by chronic alcoholism (3 patients). Confusional state was the most frequent symptom found in 4 patients. The characteristic clinical triad of confusion, oculomotor disorders and ataxia was only found in 2 patients. Neuroimaging showed a typical aspect in 3 patients. The serum levels of thiamine were low in five patients and normal in two patients. After receiving parental than oral thiamin supplementation, three patients were independent after one month with a mRS score <3.

Conclusions

GWE is an acute neuropsychiatric emergency. Chronic alcoholism is recognized as its most common cause. The clinical triad is not constantly present. MRI shows typically bilateral symmetrical hyperintensities in periaqueductal area, periventricular region, thalami and mammillary bodies. Thiamin level can be normal since it does not accurately represent body thiamine status or in case of mutations in a thiamine-transporter gene. Thiamine therapy is warranted if any component of the GWE triad is present in an appropriate clinical setting to prevent irreversible neurological sequelae.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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