J Neurol Neurosurg Spine | Volume 2, Issue 1 | Case Report | Open Access

A Case of Wernicke’s Encephalopathy Responsive to Thiamine as Initial Presentation of HIV Seropositivity

Kamel E*, Yerokhin O and Ionete C

Department of Neurosurgery, University of Massachusetts Medical School, USA

*Correspondance to: Edouard Kamel 

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Abstract

Wernicke’s Encephalopathy (WE), classically seen in alcoholics has also been described in cases of AIDS with severe malnourishment. We would like to share our experience with an otherwise previously asymptomatic patient with no known WE risk factors who presented with acute truncal ataxia consistent with WE leading to the diagnosis of AIDS. A 46-year-old woman presented for acute onset progressive gait unsteadiness and somnolence. She otherwise denied any disorientation, memory deficits, vertigo, weakness or numbness. She did not experience any weight loss or diarrhea and did not drink alcohol. Her only medical history was a chronic normocytic anemia and three episodes of left lower lobe pneumonia. She was not on any medications. Her full neurologic examination was unremarkable except for a pronounced truncal ataxia.Neuroimaging did not show any acute abnormalities. As part of the workup for pancytopenia we performed HIV testing that was positive. The patient was empirically initiated on IV Thiamine from day 1 and steadily improved. She was safely discharged home after six days, requiring no assistance with ambulation.Muri et al. evaluated the thiamine status in 55 HIV-positive patients without typical WE risk factors and found evidence of thiamine deficiency that did not correlate with the nutritional status or CD4 count. The pathophysiology of thiamine deficiency in asymptomatic HIV patients without any known WE risk factors remain unclear. We would recommend keeping HIV infection in the differential in patients presenting with symptoms of Wernicke’s encephalopathy even without any known risk factors.

Keywords:

Wernicke’s encephalopathy; HIV; Thiamine; Truncal ataxia

Citation:

Kamel E, Yerokhin O, Ionete C. A Case of Wernicke’s Encephalopathy Responsive to Thiamine as Initial Presentation of HIV Seropositivity. J Neurol Neurosurg Spine. 2017; 2(1): 1008.

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