Journal List > Korean J Clin Neurophysiol > v.16(1) > 1084132

Kim and Oh: A Case of Wernicke's Encephalopathy Presenting as Acute Bilateral Wrist Drop

Abstract

Thiamine deficiency can cause peripheral polyneuropathy and Wernicke’s encephalopathy. Wernicke’s encephalopathy is characterized by ataxia, ophthalmoplegia, nystagmus, and confusion, and typically presents acute and rapidly progressive course, whereas peripheral neuropathy associated with thiamine deficiency manifests chronic and slowly progressive one. However, acute and rapidly progressive axonal polyneuropathy combined with Wernicke’s encephalopathy is quite rare and unusual. Here, we describe a patient with Wernicke’s encephalopathy who presented with acute bilateral axonal neuropathy. (Korean J Clin Neurophysiol 2014;16:27-31)

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Figure 1.
Coronal fluid attenuated inversion recovery (FLAIR) MR images. These FLAIR images show signal intensity alterations of medial thalamus (white arrows, A) and periaqueductal area of the midbrain (white arrow, B) in an acute period of disease. After six weeks of treatment, follow-up FLAIR MR images (C and D) showed a normalized signal change in same area (A and B level) that affected by Wernicke's encephalopathy.
kjcn-16-27f1.tif
Table 1.
Result of nerve conduction study of bilateral upper and lower extremities
Latency (msec) Conduction velocity (m/sec) Amplitude (m; mV/ s; uV)
RT LT NL RT LT NL RT LT NL
Motor nerve
Median nerve NR NR ≤4.4 NR NR ≥49.96 NR NR ≥5
Ulnar nerve
Wrist 2.7 2.8 ≤3.3 7.2 5.7 ≥5
Elbow 6.8 7.1 59 65 ≥50.61 5.3 4.6
Axilla 8.5 9.7 52 51 5.1 4.7
Radial nerve NR NR ≤2.9 NR NR ≥57.2 NR NR ≥2
Peroneal nerve
EDB Ankle 5.9 3.8 ≤6.5 1.8 6.0 ≥4
B Fib 13.0 10.6 42 47 ≥41.85 1.6 4.8
Poplit 14.4 12.1 41 45 ≥40.0 1.9 4.7
TA Fib head 4.6 4.2 ≤6.7 ≥40.5 5.0 5.3 ≥5.0
Poplit 6.4 6.1 44 45 5.0 5.1
Tibial nerve
Ankle 3.7 4.5 ≤5.8 11.5 7.1 ≥5.0
Knee 11.6 11.9 48 51 ≥40.63 9.4 5.1
Sensory nerve
Median nerve NR NR ≤3.5 NR NR ≥41.26 NR NR ≥10
Ulnar nerve 2.7 2.7 ≤3.1 38 35 ≥39.26 40.5 45.6 ≥10
Radial nerve 2.7 NR ≤3.1 37 NR ≥44.31 3.8 NR ≥10
Peroneal nerve 1.8 2.2 ≤4.4 56 64 ≥40.5 4.1 4.8 ≥4.0
Sural nerve 2.6 2.3 ≤4.4 46 52 ≥34.68 8.2 13.4 ≥6.0

RT; right, LT; left, NL; normal range, NR; no response, m; motor, s;sensory, EDB; extensor digitoriumbrevis, TA; tibialis anterior, B Fib; below fibular head, Poplit; popliteal fossa, Fib head; fibular head.

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