CH Ko, WL Lau, WW Cheng

Abstract

We report an adolescent who led a high risk lifestyle with ketamine abuse, unhealthy eating habits, smoking and social drinking. He developed prominent mental status changes, unsteady gait and paranoid ideations after an episode of viral illness. The diagnosis of Wernicke's encephalopathy was established on the MRI findings of symmetrical high signal intensity in bilateral medial thalami, associated with reduction of red blood cell transketolase activity. There was prompt clinical, radiological, and biochemical improvement after thiamine therapy. Psychological testing during convalescence identified residual working memory deficits. We review recent updates in the diagnosis and management of this medical emergency. Emergency physician should be aware of this neuropsychiatric syndrome in predisposed adolescents, as early instillation of thiamine is vital to reverse the potentially fatal disorder.