Case Study presented by Gina Creutzburg and Cindy Myers, page 2

Case Questions

What is the major problem causing these neurological deficits?

Nutritional deficiencies caused by the partial gastrectomy and gastrojejunostomy that were exacerbated by the recent respiratory illness and poor appetite.

Thiamine is the major deficient vitamin.

Human Thiamine Deficiency Diseases

In developed countries, clinically significant thiamine deficiency is rare except as a complication of severe alcoholism or other disorders impairing nutiltion. It is more common in developing countries where polished rice is the staple grain.More prolonged thiamine deficiency frequently leads to damage to peripheral nerves. This neuropathy tends to be worse distally than proximally (stocking-glove), involves myelin more than axons, and is often painful. The neuropathy may be linked to deficiencies in multiple water-soluble vitamins known for historical reasons as the vitamin B complex.

  Our syndrome usually consists of acute and chronic phases. The acute phase consists of a staggering gait, paralysis of eye movements, and confusion, associated with small hemorrhages along the third and fourth ventricles and reduced cerebral metabolic rate as measured by cerebral blood flow. Injections of thiamine can be life-saving, with clinical improvement often evident within minutes. It is believed that prompt treatment can prevent the chronic phase. In the chronic phase, a striking loss of working memory accompanies relatively little loss of reference memory. Affected patients characteristically make up stories in response to leading questions (confabulate). In this phase, patients do no respond to thiamine treatment.

In our case, signs of  the acute phase, truncal ataxia, hyporeflexia of the ankles, and confusion, presents simultaneously with the chronic phase represented by memory deficits.