Case Study: The Vomiting Vegetarian

MBBS
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A 26-year-old woman presents with progressive weakness, unsteady gait, and occasional confusion. She has been vomiting off and on for the past month and recently became too weak to walk without assistance. She’s a strict vegetarian, drinks occasionally, and recently lost significant weight.

On examination:

  • Vital signs: Normal
  • Neurologically: Disoriented to time, wide-based gait, horizontal nystagmus, mild bilateral lower limb weakness
  • Romberg: Positive
  • Reflexes: Brisk
  • No signs of jaundice or abdominal tenderness

Labs:

  • CBC: Mild macrocytic anemia
  • Electrolytes and LFTs: Normal
  • MRI Brain: Hyperintensities in mammillary bodies and periventricular areas

What is your diagnosis?
What nutritional deficiency could explain both the neurological symptoms and imaging findings?
What is the urgency and treatment approach?

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most likely to be Wernicke encephalopathy neurological emergency vitamin b1 deficiency

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  • The patient likely has Wernicke’s encephalopathy caused by thiamine (vitamin B1) deficiency, common in malnourished or alcoholic individuals.
  • Neurological signs and MRI findings support this.
  • Treatment is urgent—high-dose intravenous thiamine must be started immediately, ideally before giving any glucose, to prevent permanent neurological damage or progression to Korsakoff syndrome.
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  • Diagnosis: Wernicke’s encephalopathy due to thiamine (Vitamin B1) deficiency.
  • Causes: Likely due to inadequate nutrition from strict vegetarian diet and significant weight loss.
  • Urgency: Medical emergency requiring prompt treatment to prevent long-term brain damage or death.
  • Treatment: Immediate high-dose thiamine supplementation (IV or IM) and nutritional support.
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Wernicke’s encephalopathy cause vitamin B1 deficiency.

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