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Non-alcoholic Wernicke encephalopathy presenting as bilateral hearing loss: a case report

  • Luca ProsperiniEmail author
  • Alessandro Stasolla
  • Gabriella Grieco
  • Carmela Gerace
  • Carla Tortorella
Letter to the Editors
  • 17 Downloads

Dear Sirs,

Wernicke encephalopathy (WE) is a syndrome caused by thiamine deficiency whose main clinical features are ophthalmoplegia, ataxia, and altered mental state. This symptom triad can be incomplete, especially in the first few weeks from the onset [1]. WE is typically described as complication of a long-standing history of alcohol abuse, but there is an increase of non-alcoholic cases, mainly due to iatrogenic causes [2].

Here, we report a case of iatrogenic WE in a patient presenting with sudden bilateral deafness 2 months after bariatric surgery.

A 27-year-old-man was admitted to the emergency room (ER) with rapidly progressing bilateral hearing loss followed by balance disturbance and diplopia. Bilateral hypoacusis started few days before and was initially misdiagnosed as otitis media. His relatives reported sleeve gastrectomy approximately 2 months before, followed by recurrent vomiting, and poor compliance with supplementation dietary prescribed after surgery.

General...

Notes

Funding

LP: consulting fees from Biogen, Novartis and Roche; speaker honoraria from Biogen, Genzyme, Merck Serono, Novartis and Teva; travel grants from Biogen, Genzyme, Novartis and Teva; research grants from the Italian MS Society (Associazione Italiana Sclerosi Multipla) and Genzyme. CT: honoraria for speaking and travel grant from Biogen, Sanofi-Aventis, Merck Serono, Bayer-Schering, Teva, Genzyme, Almirall and Novartis. AS, GG, CG: none declared.

Compliance with ethical standards

Ethical approval

The patient provided informed oral and written consent in accordance with specific national laws and the ethics standards laid down in the 1964 Declaration of Helsinki and its later amendments.

References

  1. 1.
    Reuler JB, Girard DE, Cooney TG (1985) Wernicke’s encephalopathy. N Engl J Med 312:1035–1039CrossRefGoogle Scholar
  2. 2.
    Scalzo SJ, Bowden SC, Ambrose ML, Whelan G, Cook MJ (2015) Wernicke–Korsakoff syndrome not related to alcohol use: a systematic review. J Neurol Neurosurg Psychiatry 86:1362–1368Google Scholar
  3. 3.
    Walker MA, Zepeda R, Afari HA, Cohen AB (2014) Hearing loss in Wernicke encephalopathy. Neurol Clin Pract 4:511–515CrossRefGoogle Scholar
  4. 4.
    Galvin R, Bråthen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA, EFNS (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 17:1408–1418CrossRefGoogle Scholar
  5. 5.
    Singh S, Kumar A (2007) Wernicke encephalopathy after obesity surgery: a systematic review. Neurology 68:807–811CrossRefGoogle Scholar
  6. 6.
    Caine D, Halliday G, Kril J, Harper C (1997) Operational criteria for the classification of chronic alcoholics: identification of Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry 62:51–60CrossRefGoogle Scholar
  7. 7.
    Foster D, Falah M, Kadom N, Mandler R (2005) Wernicke encephalopathy after bariatric surgery: losing more than just weight. Neurology 65:1987CrossRefGoogle Scholar
  8. 8.
    Kohrman DC, Wan G, Cassinotti L, Corfas G (2019) Hidden hearing loss: a disorder with multiple Etiologies and mechanisms. Cold Spring Harb Perspect Med. pii: a035493CrossRefGoogle Scholar
  9. 9.
    Chaves LC, Faintuch J, Kahwage S, Alencar Fde A (2002) A cluster of polyneuropathy and Wernicke–Korsakoff syndrome in a bariatric unit. Obes Surg 12:328–334CrossRefGoogle Scholar
  10. 10.
    Moser T, Starr A (2016) Auditory neuropathy—neural and synaptic mechanisms. Nat Rev Neurol 12:135–149CrossRefGoogle Scholar
  11. 11.
    Oudman E, Wijnia JW, van Dam M et al (2018) Preventing wernicke encephalopathy after bariatric surgery. Obes Surg 28:2060–2068CrossRefGoogle Scholar
  12. 12.
    Kattah JC, Dhanani SS, Pula JH, Mantokoudis G, Tehrani ASS, Toker DEN (2013) Vestibular signs of thiamine deficiency during the early phase of suspected Wernicke encephalopathy. Neurol Clin Pract 3:460–468CrossRefGoogle Scholar
  13. 13.
    Lee SH, Kim SH, Kim JM, Tarnutzer AA (2018) Vestibular dysfunction in Wernicke’s encephalopathy: predominant Impairment of the horizontal semicircular canals. Front Neurol 9:141CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of NeurosciencesS. Camillo-Forlanini HospitalRomeItaly
  2. 2.Emergency DepartmentS. Camillo-Forlanini HospitalRomeItaly

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