Roçi E, Mara E, Dodaj S, Vyshka G. Wernicke encephalopathy presenting as a stroke mimic: A case report. World J Clin Cases 2025; 13(19): 103585 [DOI: 10.12998/wjcc.v13.i19.103585]
Corresponding Author of This Article
Gentian Vyshka, MD, Professor, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Rr. Dibres 371, Tirana 1005, Albania. gvyshka@gmail.com
Research Domain of This Article
Neurosciences
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ermir Roçi, Stroke Unit, Service of Neurology, University Hospital Center Mother Theresa, Tirana 1005, Albania
Emili Mara, Stela Dodaj, Stroke Unit, University Hospital Center Mother Teresa, Tirana 1005, Albania
Gentian Vyshka, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
Author contributions: Roçi E, Mara E and Dodaj S were responsible for patient diagnosis, treatment and follow up, drafting of the manuscript; Mara E and Vyshka G were responsible for manuscript writing and review of literature; all of the authors read and approved the final version of the manuscript to be published.
Informed consent statement: The study participant’s legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gentian Vyshka, MD, Professor, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Rr. Dibres 371, Tirana 1005, Albania. gvyshka@gmail.com
Received: November 25, 2024 Revised: February 16, 2025 Accepted: February 24, 2025 Published online: July 6, 2025 Processing time: 115 Days and 16.3 Hours
Abstract
BACKGROUND
Several conditions may present with acute neurological symptoms, thus mimicking the presentation of stroke. Although the underlying disorder can be diagnosed after careful medical, neurological, and radiological examinations, a few conditions, such as Wernicke encephalopathy (WE), may present a particular diagnostic difficulty. WE is a neurological disorder caused by deficiency of thiamine (B1 vitamin), most often resulting from alcoholism, malnutrition, hyperemesis gravidarum or bariatric surgery. The diagnosis of WE in a certain historical, clinical setting is easily suggested, but in a few cases presenting with acute neurological deficits, it can be particularly challenging.
CASE SUMMARY
We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities, dizziness and a confusional state, which had lasted for approximately 30 minutes. The patient had a similar episode of a confusional state approximately two months earlier; at that time, a transient ischemic attack was suspected and he was started on aspirin. The initial clinical evaluation and imaging findings were unremarkable for stroke, but the patient’s symptoms, history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE. Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis.
CONCLUSION
Through this case report, we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke, especially when the presentation is atypical or when risk factors for thiamine deficiency are present. Since intravenous thiamine significantly improves outcomes, delayed recognition and treatment in some cases might be deleterious.
Core Tip: Wernicke encephalopathy (WE) is a neurological disorder caused by the deficiency of thiamine (B1 vitamin), most often resulting from alcoholism, malnutrition, hyperemesis gravidarum or bariatric surgery. The diagnosis in a certain clinical setting might be easy, but in a few cases presenting with acute neurological deficits it can be particularly challenging. A 63-year-old male presented to the emergency department with left limbs weakness, dizziness and confusion that lasted 30 minutes. Brain magnetic resonance imaging (MRI) was performed and revealed hyperintense signals in several sequences, involving mammillary and hypothalamic regions, and adjacent midbrain and subthalamic nuclei. Therefore, based on the history taking, symptoms of confusion and ataxia, as well as MRI findings, WE was diagnosed. Parenteral thiamine was started as well as diuretics for hepatic cirrhosis.
