https://doi.org/10.4081/monaldi.2023.2513

Wernicke encephalopathy and beriberi disease presenting as STEMI-equivalent

Cerebral MRI revealing a diffuse, bilateral and symmetric areas of increased T2 signal in the thalamus, hypothalamus and mamillary bodies, highly suggestive of Wernicke encephalopathy.
Vol. 93 No. 4 (2023)
Submitted: December 30, 2022
Accepted: February 2, 2023
Published: February 16, 2023
Wernicke Encephalopathy, Shark-fin, Thiamine deficiency
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Authors

Miguel Martins Carvalho
jmiguelmartinscarvalho@gmail.com
https://orcid.org/0000-0003-0671-009X
Department of Cardiology, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Portugal.
Tânia Proença
Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Ricardo Alves Pinto
https://orcid.org/0000-0003-1002-9985
Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Roberto Pinto
https://orcid.org/0000-0003-0472-4076
Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Filipe Macedo
Department of Cardiology, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Portugal.

Thiamine deficiency is commonly associated with malnutrition, alcoholism and bariatric surgery. Thiamine deficiency can manifest in different ways, especially in developing countries: as peripheric neuropathy, as Wernicke encephalopathy or as beriberi disease. The authors present the case of a 72-year-old male, with a hiatal hernia that led to thiamine deficiency due to malnutrition. The initial clinical manifestation was an ST-elevation myocardial infarct equivalent, an ECG with a shark-fin pattern that evolved to a Wellens type B pattern. The patient evolved with severe altered mental status. A Wernicke encephalopathy diagnosis was confirmed by MRI; the patient was medicated with high-dose thiamine, with quick recovery, both neurologic and cardiac. The clinical history and response to treatment confirm the diagnosis of Wernicke encephalopathy and beriberi disease.

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How to Cite

Martins Carvalho, Miguel, Tânia Proença, Ricardo Alves Pinto, Roberto Pinto, and Filipe Macedo. 2023. “Wernicke Encephalopathy and Beriberi Disease Presenting As STEMI-Equivalent”. Monaldi Archives for Chest Disease 93 (4). https://doi.org/10.4081/monaldi.2023.2513.
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