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Non-alcoholic Wernicke encephalopathy: great masquerader
  1. Chukwudumebi Okafor1,
  2. Manojna Nimmagadda1,
  3. Sarthak Soin1 and
  4. Lavanya Lanka2
  1. 1 Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA
  2. 2 Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
  1. Correspondence to Dr Sarthak Soin, sarthaksoin{at}


Thiamine is an important coenzyme, which is essential for metabolism and maintaining cellular osmotic gradient. Thiamine deficiency can cause focal lactic acidosis, alteration of the blood–brain barrier and the production of free radicals through cell death by necrosis and apoptosis. Wernicke encephalopathy (WE) is a clinical diagnosis. Cytotoxic and vasogenic oedema are the most typical neuroimaging findings of WE, presenting as bilateral symmetrical hyperintense signals on T2-weighted MR images. MRI is not necessary for the diagnosis of WE, but it can be helpful in ruling out alternative diagnosis. We present the case of an 61-year-old man with the history of class II obesity presenting with diplopia, dysarthria and vertigo, confirmed to be non-alcoholic WE. We aim to highlight the occurrence of WE in patients with large bowel resection though. Delay in diagnosis, particularly in obese individuals due to lack of suspicion, can lead to grim prognosis.

  • nutrition and metabolism
  • malnutrition
  • nutritional support
  • vitamins and supplements

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  • Contributors CO and MN contributed equally in writing of the manuscript. SS and LL reviewed and revised the final manuscript prior to submission. CO is the article guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.