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J R Soc Med 2007;100:538
doi:10.1258/jrsm.100.12.538-a
© 2007 Royal Society of Medicine

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J R Soc Med 2007;100:538
© 2007 The Royal Society of Medicine

Letters

Wernicke's encephalopathy in a funny patient

W Kittisupamongkol

Email: weekitti{at}gmail.com

Sojer and colleagues describe a diabetic patient presenting with a month of periodic cognitive impairment due to hypoglycaemia.1 However, a sentence of indispensable personal history should have been included. Significant alcohol consumption could raise a possibility of Wernicke's encephalopathy. This disease is often unrecognized but detrimental if left untreated. The classic triad of mental status change, ophthalmoplegia and truncal ataxia is present in only 16% of patients.2 Failure to include this encephalopathy among differentials of mental status change in such patients and to give intravenous thiamine before glucose accordingly in the setting of hypoglycaemia would lead the patient to worsening status.2

Last but not least, I have seen quite a few alcoholics, and have learnt that a practical question should be ‘when was your last drink?’ rather than ‘do you use alcohol?’

Footnotes

Competing interests None declared.

REFERENCES

  1. Sojer M, Eller P, Schmidauer C, Pechlaner C. A funny patient. J R Soc Med2007; 100:478 -9[Free Full Text]

  2. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6:442 -55[Medline]


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This Article
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