Wernicke-Korsakoff syndrome with psychotic symptoms in a severe case of anorexia nervosa: A case report

Abstract

Introduction

The Wernicke-Korsakoff syndrome comprises a complex of symptoms including Wernicke's encephalopathy and the Korsakoff's syndrome. While the former is characterized by a classic clinical triad of ataxia, ophtalmoplegia and a global confusional state; the Korsakoff's syndrome is characterized by memory impairment and confabulation. These two entities are now considered as a clinical spectrum of a same disease caused by deficiency of thiamine (vitamin B1).

Objective

To describe a case of Wernicke-Korsakoff Syndrome with psychotic symptoms in a 13-year-old female patient with anorexia nervosa.

Method

The patient and family were interviewed. Literature relevant to the case was reviewed.

Results

A 13-year-old Caucasian female was admitted to the emergency department with bradycardia (38 bpm) and a two-month history of weight loss totaling 6 kg. This loss of weight was a result of dietary restriction and over-exercise because she “felt too fat”. On admission she has a body mass index of 12.17. She was diagnosed with anorexia nervosa and was hospitalized. On day 11 after hospitalization, patient initiated alteration in behavior, fluctuating mental state with periods of lucidity and periods of confusion, memory impairment and psychotic symptoms, with paranoid delusions and auditory hallucinations. The classic triad of Wernicke's encephalopathy was not present. The treatment with thiamine was initiated and the symptoms including psychotic symptoms improved.

Conclusion

Wernicke-Korsakoff syndrome should be considered in cases of anorexia nervosa with a confusional state and memory impairment even if the classic symptoms are not present.

Disclosure of interest

The authors have not supplied their declaration of competing interest.