Acute Wernicke’s Encephalopathy in a Chronic Alcohol User: Clinical Presentation, MRI Findings, and Treatment Response

Madadi Mahani, Ali; Ahmadi, Bizhan; Hajghani, Ali; Ghani Rayeni, Mohammadmahdi

doi:10.30477/cjm.2025.530413.1105

Acute Wernicke’s Encephalopathy in a Chronic Alcohol User: Clinical Presentation, MRI Findings, and Treatment Response

Articles in Press

Document Type : Case Report

Authors

Ali Madadi Mahani ¹

bizhan ahmadi ²

Ali Hajghani ¹

Mohammadmahdi Ghani Rayeni ¹

¹ Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

² Gastroenterology Department, Kerman University of Medical Sciences, Kerman, Iran

10.30477/cjm.2025.530413.1105

Abstract

This case report is about a 37-year-old man who came to the emergency room with the chief complaint of a decrease in level of consciousness. According to the history given by his family, he had a heavy alcohol consumption (about one liter per day) for the past four years. In Neurological exams, he showed signs of ataxia (loss of coordination), strabismus because of sixth cranial nerve damage. Based on clinical signs and MRI findings (showing signal changes in the periaqueductal region and mammillary bodies), the diagnosis of Wernicke’s Encephalopathy (WE) was confirmed, with no evidence of progression to Korsakoff Syndrome (WKS). The patient was being treated with sodium valproate because of a seizure disorder. The treatment protocol was high-dose thiamine, B-complex vitamin injection, and changing sodium valproate to levetiracetam due to liver involvement. Although there were relative improvements after the treatment, sixth nerve damage was still present in the patient and needed much longer follow-ups.

Keywords

Wernicke Encephalopathy

Korsakoff Syndrome

Alcohol Use Disorder

Thiamine Deficiency

Subjects