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Wernicke's Encephalopathy as Unexpected Cause of Vertigo for Otolaryngologist- A Case Report

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Yaseen E. T., Mohammed N. T., Jasim S. H.
Polski Przegląd Otorynolaryngologiczny
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2024
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vol. 14
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issue 1
1-5
PL
Background: The causes of vertigo are diverse, and the possible differential diagnosis is extensive. Thiamine deficiency after sleeve gastrectomy is one of the rare causes for vertigo, a condition called Wernicke’s encephalopathy. Case report: This is a case report of a 20-year-old female complaining of continuous vertigo for 2 months duration. She complained about ocular, lower limbs and Gastero-intestinal clinical features after undergoing sleeve gastrectomy. She was conscious but confused. Eye movement examination revealed horizontal and vertical nystagmus. She displayed signs of ataxia. VNG revealed Up-beating nystagmus in primary gaze, leftward gaze, and upward gaze when vision is accessible, and in upward gaze when vision is denied suggesting a central etiology. Lab. tests confirmed a low serum thiamine and Vit D levels. Low thiamine raises the suspicion of Wernicke’s encephalopathy. Within 72 hours of treatment, here vertigo and ataxia began to improve, and the nystagmus reduced significantly. Over the next few days, here balance and coordination greatly improved, and here mental state improved. Conclusion: This case underscores the significancy of considering Wernicke's encephalopathy in the differential diagnosis of vertigo, especially in patients with a history of bariatric surgery, regardless of age. It also emphasizes the need for prompt thiamine supplementation in such cases, as timely intervention along with supportive treatments can significantly improve patient outcomes. Otolaryngologists should maintain a broad perspective when diagnosing vertigo to ensure accurate and effective treatment.
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