Prolonged emesis as prodromal symptom and exacerbating factor of non-alcoholic Wernicke-Korsakoff Syndrome: a costly diagnostic delay

ABSTRACT

Background. Wernicke–Korsakoff syndrome (WKS) is a serious neurological disorder caused by thiamine (vitamin B1) deficiency. The term refers to two different conditions. Wernicke encephalopathy (WE) is an acute syndrome related to the deficiency. It requires early diagnosis and emergent treatment to prevent long term consequences and even death. Korsakoff syndrome (KS) refers to the progression into chronic and irreversible amnestic-confabulatory syndrome. While WKS is better known to affect people with alcohol use disorder, it can be also associated with other causes of malnourishment, like bariatric surgery or hyperemesis gravidarum. WE is clinically late-diagnosed because of lower prevalence in non-alcoholic population. On some occasions, prolonged vomiting can be a cause, a prodromal symptom before neurological manifestations and an exacerbating factor.
Case presentation. We present a case of a 72-year-old woman with a history of gastrointestinal resection. The patient was admitted to our hospital because of recurrent emesis and worsening of neurological signs. She was previously admitted to another hospital, where doctors excessively focused on gastrointestinal symptoms, thus causing an important diagnostic delay.
Conclusions. Prevention has a prominent role in WKS. Ensuring an adequate diet, identifying risk factors and subsequently recognizing and promptly treating with intravenous vitamin supplementation are crucial to prevent devastating consequences.