Advertisement

Infection

pp 1–4 | Cite as

Early recognition of thiamine deficiency: ocular motor deficits in a patient with nutritional deprivation due to persistent antibiotic-related nausea

  • Benedikt Wiggli
  • Sandra Kapitza
  • Frank Ahlhelm
  • Alexander A. TarnutzerEmail author
Case Report

Abstract

Case description

A 73-year-old male presented with new onset dizziness and a 22-kg weight loss due to antibiotic-induced nausea/vomiting. Due to gaze-evoked nystagmus (GEN), thiamine deficiency was suspected. Within 12 h after replacement, his GEN decreased.

Conclusion

In patients with nutritional deprivation, new onset GEN should prompt further diagnostics and immediate thiamine supplementation to avoid disease progression.

Keywords

Wernicke’s disease Malnutrition Vestibular Eye movements Antibiotics 

Notes

Funding

This work was not supported by any funding.

Compliance with ethical standards

Conflict of interest

Dr. Wiggli, Dr. Kapitza, Prof. Ahlhelm and Dr. Tarnutzer do not report financial or other relationships that might lead to a perceived conflict of interest.

Supplementary material

Video 1: In the first part of the video (recorded before thiamine replacement), strong horizontal centripetal eye drift followed by centrifugal correction saccades (i.e., gaze-evoked nystagmus) can be seen. When returning gaze straight ahead, no rebound nystagmus was noted. About 12 h after thiamine replacement was started, the GEN had already clearly decreased, now being moderate and asymmetric (stronger to the left) as shown in the second section. On follow-up 2 weeks later (third section of the video), GEN had further decreased, now being very mild only (but still somewhat stronger when looking to the left)

References

  1. 1.
    Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183:E571–92.CrossRefGoogle Scholar
  2. 2.
    Tanphaichitr V. Thiamin. In: Shils ME, Olson JA, Shike M, Ross AC, editors. Modern nutrition in health and disease. 9th ed. Baltimore: Williams and Wilkins; 1999. p. 381–9.Google Scholar
  3. 3.
    Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6:442–55.CrossRefGoogle Scholar
  4. 4.
    Kattah JC. The spectrum of vestibular and ocular motor abnormalities in thiamine deficiency. Curr Neurol Neurosci Rep. 2017;17:40.CrossRefGoogle Scholar
  5. 5.
    Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemp Neurol Ser. 1971;7:1–206.PubMedGoogle Scholar
  6. 6.
    Kuriyama A, Jackson JL, Doi A, Kamiya T. Metronidazole-induced central nervous system toxicity: a systematic review. Clin Neuropharmacol. 2011;34:241–7.CrossRefGoogle Scholar
  7. 7.
    Weidauer S, Nichtweiss M, Lanfermann H, Zanella FE. Wernicke encephalopathy: MR findings and clinical presentation. Eur Radiol. 2003;13:1001–9.PubMedGoogle Scholar
  8. 8.
    Kattah JC, Dhanani SS, Pula JH, Mantokoudis G, Saber Tehrani AS, Newman-Toker DE. Vestibular signs of thiamine deficiency during the early phase of suspected Wernicke encephalopathy. Neurol Clin Pract. 2013;3:460–8.CrossRefGoogle Scholar
  9. 9.
    Lee SH, Kim SH, Kim JM, Tarnutzer AA. Vestibular dysfunction in Wernicke’s encephalopathy: predominant impairment of the horizontal semicircular canals. Front Neurol. 2018;9:141.CrossRefGoogle Scholar
  10. 10.
    Kattah JC, Guede C, Hassanzadeh B. The medial vestibular nuclei, a vulnerable target in thiamine deficiency. J Neurol. 2018;265:213–5.CrossRefGoogle Scholar
  11. 11.
    Galvin R, Brathen G, Ivashynka A, et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010;17:1408–18.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Infectiology, Department of MedicineCantonal Hospital of BadenBadenSwitzerland
  2. 2.Neurology, Department of MedicineCantonal Hospital of BadenBadenSwitzerland
  3. 3.Institute of Neuroradiology, Department of RadiologyCantonal Hospital of BadenBadenSwitzerland
  4. 4.Faculty of MedicineUniversity of ZurichZurichSwitzerland

Personalised recommendations