Apathetic encephalopathy in thyreotoxicosis: an unsual cause of wernicke encephalopathy and osmotic demyelinating syndrome: An unsual cause of wernicke encephalopathy and osmotic demyelinating syndrome

Carlotta Mutti; Rosario Ciliento; Liborio Parrino; Irene Florindo; Giovanni Pavesi; Lucia Zinno

doi:10.23750/abm.v92i1.9473

Apathetic encephalopathy in thyreotoxicosis: an unsual cause of wernicke encephalopathy and osmotic demyelinating syndrome

An unsual cause of wernicke encephalopathy and osmotic demyelinating syndrome

Authors

Carlotta Mutti Neurology Department, Parma Hospital
Rosario Ciliento Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
Liborio Parrino Sleep Medicine Center, Neurology Unit, Department of General and Specialistic Medicine, University Hospital of Parma, Parma, Italy
Irene Florindo Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
Giovanni Pavesi Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
Lucia Zinno Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy

DOI: https://doi.org/10.23750/abm.v92i1.9473

Keywords:

Apathetic Encephalopathy, Thyrotoxicosis Wernicke encephalopathy, osmotic demyelination syndrome

Abstract

Non-alcoholic Wernicke Encephalopathy (WE) is an overlooked complication of malnourishment in all its forms including undernutrition, inadequate vitamine intake and endocrinological diseases. Both delay in treatment and overtreatment can lead to severe neurological life-long consequences. Inadequate management in patients with chronic malnutrition may cause abrupt osmolytes unbalance and subsequent osmotic demyelination syndromes. We describe a 65-year old man with apathetic encephalopathy caused by thyreotoxicosis and associated with malnutrition and severe thiamine depletion.

References

Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A. MR imaging findings in alcoholic and nonalcoholic acute Wernicke's encephalopathy: a review. Biomed Res Int 2014; 2014:503596

Harper C. The incidence of Wernicke’s encephalopathy in Australia—a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry. 1983;46(7):593–598.

Kishimoto Y, Ikeda K, Murata K, Kawabe K, Hirayama T, Iwasaki Y. Rapid development of central pontine myelinolysis after recovery from Wernicke encephalopathy: a non-alcoholic case without hyponatremia. Intern Med. 2012;51(12):1599-603.

Lahey FH. Non-activated (apathetic) type of hyperthyroidism. N Engl J Med 1931; 204: 747-8

Poudel RR, Belbase B, Belbase B, Kafle NK. Apathetic thyrotoxicosis presenting with diabetes mellitus. J Community Hosp Intern Med Perspect. 2014;4(5):25502.

Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL. Wernicke Encephalopathy-Clinical Pearls. Mayo Clin Proc. 2019 Jun;94(6):1065-1072

Gossman WG, Newton EJ. Wernicke-Korsakoff Syndrome. [Updated 2017 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430729/

Santos Andrade C, Tavares Lucato L, da Graça Morais Martin M, Joaquina Marques-Dias M, Antonio Pezzi Portela L, Scarabôtolo Gattás G, da Costa Leite C. Non-alcoholic Wernicke's encephalopathy: broadening the clinicoradiological spectrum. Br J Radiol. 2010 May;83(989):437-46.

Welsh A, Rogers P, Clift F. Nonalcoholic Wernicke's encephalopathy. CJEM. 2016 Jul;18(4):309-12

Sparacia G, Anastasi A, Speciale C, Agnello F, Banco A. Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke's encephalopathy. World J Radiol. 2017;9(2):72–78.

Zuccoli G, Siddiqui N, Bailey A, Bartoletti SC. Neuroimaging findings in pediatric Wernicke encephalopathy: a review. Neuroradiology. 2010 Jun;52(6):523-9.

Shogry ME, Curnes JT. Mamillary body enhancement on MR as the only sign of acute Wernicke encephalopathy. AJNR Am J Neuroradiol. 1994;15(1):172–174

Arnold BM, Casal C, Higgins HP. Apathetic thyreotoxicosis. CMA Journal; 1974 Nov 2 , vol 111

Kopelman MD, Thomson AD, Guerrini I, Marshall EJ. The Korsakoff syndrome: clinical aspects, psychology and treatment. Alcohol Alcohol. 2009;44(2):148–154.

Mascarenhas JV, Jude EB. Central pontine myelinolysis: electrolytes and beyond. BMJ Case Rep. 2014 Mar 28;2014.