Sarah Hasan Siddiqui
Aga Khan University Hospital, Pakistan
Title: Wernicke’s encephalopathy presenting as acute visual loss in a young patient
Biography
Biography: Sarah Hasan Siddiqui
Abstract
A 25 year old lady presented with persistent vomiting and constipation after having undergone laprotomy twice for bowel perforation 2 months back. In addition to the conservative management for her bowel obstructive symptoms, she was started on parenteral nutrition. After 7 days, she complained of sudden onset of visual loss. Examination revealed bilateral limited abduction, papilledema with some retinal hemorrhages along with slight psychomotor slowness, disorientation and drowsiness. Initial MRI brain with contrast along with diffusion weighted images was unremarkable. CSF studies along with opening pressure were also normal. Repeat MRI brain revealed T2 signal abnormalities in mamillary bodies and basal ganglia. A working diagnosis of Wernicke’s encephalopathy was made and she was started on intravenous thiamine. Significant improvement was noted over the next few days in her vision along with improvement in eye movements as well as orientation. Complex clinical picture of long standing bowel problems requiring parenteral nutrition followed by sudden onset on visual loss and Papilledema is an unusual presentation of Wernicke’s encephalopathy and such presentation should be kept in mind to avoid diagnostic delays.