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A 35-year-old man presented after 20 days of vomiting, severe loss of appetite and generalized weakness. Over the preceding 10 days he had also developed unsteady walking and slurred speech, followed by altered mental status. He was severely underweight and had neurologic findings including disorientation, abnormal eye movements and weakness of eye movement.
Brain MRI showed the characteristic pattern of Wernicke encephalopathy, a neurologic emergency caused by thiamine deficiency. Abdominal imaging also revealed thickening around the gastric outlet and multiple liver lesions. Endoscopy showed ulcerated disease involving the antrum, pylorus and duodenum, and biopsy confirmed moderately differentiated gastric adenocarcinoma. The liver metastases established Stage IV disease.
He was treated urgently with intravenous thiamine for Wernicke encephalopathy and had marked neurologic recovery after treatment.
This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full
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