Good Response to Thiamine in Bilateral Thalamic Infarction Simulating a Wernicke Syndrome: Does it Has a Role in Acute Stroke?
Received Date: May 17, 2021; Published Date: June 24, 2021
The classic clinical triad of Bilateral Thalamic Infarction is consciousness compromise, ocular motility disturbances, and cognitive deterioration; and would be an obligatory differential diagnosis of Wernicke´s Syndrome, which usually has, as clinical findings, altered mental status, ataxic gait and ophtalmoplegia. While Wernicke´s Syndrome is frequently associated with alcohol intake, it is known that there are some cases not related to alcohol consumption, these subtypes are called atypical non-alcoholic Wernicke´s Syndrome and are provoked by malnutrition as their most important etiology. Clinical case: female patient, admitted to our hospital with sudden installation of postural instability, tendency to drowsiness, nausea, dysarthria and provoked-type confabulation, initially diagnosed as an atypical non-alcoholic Wernicke´s Syndrome, with a first cerebral tomography without alterations and good response to thiamine infusion. In a second image study, a Bilateral Thalamic Infarction was evidenced. According to many reviews, the use of thiamine in acute stroke is not useful; and would be recommended in the neuro-rehabilitation phase. The clinical regression of symptoms and signs, in our patient, would be the natural history of some series of patients with Bilateral Thalamic Infarction described in the literature; but, we propose that it could also be explained in a bilateral thalamic dysfunction previously described in Wernicke´s Syndrome, and its fast response to thiamine use; so it would be interesting publishing more clinical reports or trials using thiamine in this specific type of stroke.
Keywords:Bilateral Thalamic Infarction; Wernicke Syndrome; Thiamine; Acute Stroke