Uncommon diseases of the brain in the practice of a neurologist and family doctor: Wernicke's encephalopathy (clinical analysis and differential diagnosis)

Abstract

The article examines a clinical case of Wernicke's encephalopathy in a 34-year-old man who abused alcohol. The initial impression of the patient's condition was suspected of poisoning by surrogate alcohol, botulinum toxin, multiple sclerosis, Lyme disease, acute multiple encephalomyelitis, etc., because the anamnestic data on alcohol abuse could not be detected immediately. Specific triad of clinical manifestations - cognitive decline, ocular symptoms (nystagmus, diplopia, ptosis), ataxia, which appeared after alcohol abuse, specific changes on MRI (revealed damage to the thalamus with dilated ventricles and loss of density in mammillary bodies. As a rule, symmetrical in the midbrain, hypothalamus and cerebellum. Blood test for vitamin B1 confirmed the diagnosis.Treatment with vitamin B1 caused regression of symptoms, improved the patient's condition.Additional methods (history, cerebrospinal fluid analysis, blood for thyroid hormones and infectious pathogens) contributed to the differential diagnosis and exclusion of other diagnoses. Further in the article the analysis of clinical thinking in the process of diagnosis and differential diagnosis, establishment of this diagnosis in the historical aspect, unity and differences with Korsakov syndrome, epidemiological, pathogenetic, clinical, prognostic and treatment-and-prophylactic aspects of Wernicke's encephalopathy are presented.