PT  - JOURNAL ARTICLE
AU  - Timothy Xin Zhong Tan
AU  - Kheng Choon Lim
AU  - Charles Chan Chung
AU  - Than Aung
TI  - Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy
AID  - 10.1136/bcr-2018-227412
DP  - 2019 Jan 01
TA  - BMJ Case Reports
PG  - e227412
VI  - 12
IP  - 1
4099  - http://casereports.bmj.com/content/12/1/e227412.short
4100  - http://casereports.bmj.com/content/12/1/e227412.full
SO  - BMJ Case Reports2019 Jan 01; 12
AB  - A 56-year-old teetotaller man with hypertension and gout presented with a week duration of painless worsening diplopia on a background of loss of weight and appetite, generalised lethargy and weakness for 1 year. On examination, he was noted to be hypothermic and tachycardic with generalised muscle wasting. Proximal myopathy, lower limb fasciculations and areflexia, restricted bilateral eye abduction and nystagmus were observed. Blood investigations demonstrated compensated lactic acidosis, acute kidney injury and leucocytosis. A nerve conduction study showed severe length-dependent axonal sensorimotor polyneuropathy. This was a diagnostic dilemma until an MRI brain revealed symmetrical signal abnormality and enhancement in the periaqueductal area indicative of Wernicke’s encephalopathy, caused by thiamine deficiency from poor nutrition. Beriberi, also caused by thiamine deficiency, accounted for his tachycardia, polyneuropathy, areflexia, hypothermia and biochemical abnormalities. Both beriberi and Wernicke’s encephalopathy are medical emergencies, which were treated with intravenous thiamine to good effect.