Ann Rehabil Med.  2017 Feb;41(1):158-161. 10.5535/arm.2017.41.1.158.

Hypothermia Presenting in Wernicke Encephalopathy: A Case Report

• Hong SH
• Oh JS
• Lee CH
• Oh JH

• KMID: 2383691
• DOI: http://doi.org/10.5535/arm.2017.41.1.158

Abstract

Wernicke encephalopathy (WE) is a neurologic disorder characterized by clinical symptoms, such as nystagmus, ataxia, and mental confusion. Hypothermia in patients with WE is a rare complication, and its pathogenic mechanism and therapy are yet to be ascertained. Herein, we presented a case of a 61-year-old man who was diagnosed with WE 3 months earlier. We investigated the cause of hypothermia (35.0℃) that occurred after an enema (bowel emptying). Brain magnetic resonance imaging revealed mammillary body and hypothalamus atrophy. In the autonomic function test, the sympathetic skin response (SSR) test did not evoke SSR latencies on both hands. In addition, abnormal orthostatic hypotension was observed. Laxative and stool softener medication were administered, and his diet was modified, which led to an improvement in constipation after 2 weeks. Moreover, there was no recurrence of hypothermic episode. This is the first reported case of late-onset hypothermia secondary to WE.

Keyword

Hypothermia; Wernicke encephalopathy

MeSH Terms

Ataxia
Atrophy
Brain
Constipation
Diet
Enema
Hand
Humans
Hypotension, Orthostatic
Hypothalamus
Hypothermia*
Magnetic Resonance Imaging
Mammillary Bodies
Middle Aged
Nervous System Diseases
Recurrence
Skin
Wernicke Encephalopathy*

Figure

• 

  Fig. 1 Magnetic resonance imaging of a 61-year-old man with mental confusion, ataxic gait, ocular symptoms and hypothermia. Axial fluid attenuated inversion recovery T2-weighted image showed diffuse 3rd ventricle enlargement with hypothalamus atrophy (circle).

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  Fig. 2 Sagittal spin echo T1 view image showed atrophy of 3rd ventricular floor (hypothalamus) and mammillary body (arrow).

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  Fig. 3 Autonomic function test. (A) The sympathetic skin response (SSR) test did not evoke SSR latencies on both hands. (B) Abnormal orthostatic hypotension was observed with a systolic blood pressure drop of up to 39 mmHg, caused by sudden rising from recumbent position.

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