SHM Converge Scientific Abstract ePoster Gallery-The Lingering Effects of Thiamine Deficiency

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This case describes a 24-year-old woman who developed Wernicke’s encephalopathy after sleeve gastrectomy, severe vomiting, poor intake, and malabsorption led to profound thiamine deficiency. She presented in hypovolemic shock with altered mental status, required ICU care, vasopressors, and intubation, and was found to have a very low vitamin B1 level and MRI findings typical of Wernicke’s encephalopathy, including mammillary body atrophy and thalamic/periaqueductal abnormalities.<br /><br />She received aggressive parenteral thiamine and correction of other vitamin deficiencies, and her mental status gradually improved. However, her recovery was prolonged and complicated by persistent hypophonia, dysphagia, and bilateral motor weakness, especially on the right. Her hospital course also included ventilator-associated pneumonia, ileus, and reintubation. After a two-month stay, she was discharged to a skilled nursing facility for rehabilitation.<br /><br />The main question was why neurologic and motor deficits persisted despite vitamin repletion. Evaluation suggested two possible contributors: critical illness neuropathy from prolonged ICU stay and nutritional axonal neuropathy related to severe deficiency and rapid weight loss. EMG showed an asymmetric length-dependent axonal sensorimotor polyneuropathy with proximal myopathy, and sural nerve biopsy showed generalized axonal neuropathy without vasculitis.<br /><br />The report emphasizes that Wernicke’s encephalopathy may coexist with peripheral axonal neuropathy, causing lingering weakness even after thiamine is corrected. While most cases improve quickly, severe thiamine deficiency can lead to prolonged neurologic sequelae, highlighting the need for early recognition, aggressive treatment, and rehabilitation.

Asset Subtitle

Martha C. Lopez Siles

Meta Tag

Author List Hyeon Park, Jenna Laughlin, Martha C. Lopez Siles, Shilpa Singh

Category Clinical Vignettes

Concept Wernicke Encephalopathy

Concept Thiamine Deficiency

Concept Intravenous Thiamine

Concept Alcohol Use

Concept Malabsorption

Distinguished Non-Finalist

Presenter Organization Christiana Care

Presenting Author Martha C. Lopez Siles

Track Adult

Keywords

Wernicke’s encephalopathy

sleeve gastrectomy

thiamine deficiency

hypovolemic shock

altered mental status

mammillary body atrophy

axonal sensorimotor polyneuropathy

critical illness neuropathy

vitamin B1

dysphagia

Wernicke Encephalopathy

Thiamine Deficiency

Intravenous Thiamine

Alcohol Use

Malabsorption