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Wernicke's encephalopathy presenting as acute psychosis after gastric bypass.
J Emerg Med. 2012 Nov; 43(5):811-4.JE

Abstract

BACKGROUND AND OBJECTIVES

Patients frequently present to the Emergency Department (ED) with psychiatric complaints. The differential diagnosis for acute psychosis is extensive, and determining a possible etiology requires a thorough history and physical. Small details can help the physician in differentiating organic disease from non-organic disease. Many times patients are thought to be "crazy" without a thorough history and physical being done.

CASE REPORT

In this case, the diagnosis hinged on the history of having gastric bypass surgery. A thorough physical examination was performed, and the patient had neurologic findings suggestive of severe thiamine deficiency. The patient's thiamine level was low. The patient was started on i.v. thiamine and slowly began to recover.

CONCLUSION

Cerebral beriberi, more commonly known as Wernicke's encephalopathy, is a difficult diagnosis to make in the ED. A thorough neurologic examination is difficult to perform in the ED environment, but it is necessary when trying to determine the etiology of the patient's altered mental status. The number of patients with Wernicke's encephalopathy may increase with bariatric surgery becoming more common. This disease can present with a wide variety of findings, and the classic triad is not very common. With this in mind, the physician should have a low threshold for administering thiamine intravenously.

Authors+Show Affiliations

Emergency Medicine Residency, York Hospital, York, Pennsylvania 17404, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19406605

Citation

Walker, Jonathan, and Andrew Kepner. "Wernicke's Encephalopathy Presenting as Acute Psychosis After Gastric Bypass." The Journal of Emergency Medicine, vol. 43, no. 5, 2012, pp. 811-4.
Walker J, Kepner A. Wernicke's encephalopathy presenting as acute psychosis after gastric bypass. J Emerg Med. 2012;43(5):811-4.
Walker, J., & Kepner, A. (2012). Wernicke's encephalopathy presenting as acute psychosis after gastric bypass. The Journal of Emergency Medicine, 43(5), 811-4. https://doi.org/10.1016/j.jemermed.2009.03.025
Walker J, Kepner A. Wernicke's Encephalopathy Presenting as Acute Psychosis After Gastric Bypass. J Emerg Med. 2012;43(5):811-4. PubMed PMID: 19406605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Wernicke's encephalopathy presenting as acute psychosis after gastric bypass. AU - Walker,Jonathan, AU - Kepner,Andrew, Y1 - 2009/05/05/ PY - 2008/10/18/received PY - 2009/01/29/revised PY - 2009/03/26/accepted PY - 2009/5/2/entrez PY - 2009/5/2/pubmed PY - 2013/4/23/medline SP - 811 EP - 4 JF - The Journal of emergency medicine JO - J Emerg Med VL - 43 IS - 5 N2 - BACKGROUND AND OBJECTIVES: Patients frequently present to the Emergency Department (ED) with psychiatric complaints. The differential diagnosis for acute psychosis is extensive, and determining a possible etiology requires a thorough history and physical. Small details can help the physician in differentiating organic disease from non-organic disease. Many times patients are thought to be "crazy" without a thorough history and physical being done. CASE REPORT: In this case, the diagnosis hinged on the history of having gastric bypass surgery. A thorough physical examination was performed, and the patient had neurologic findings suggestive of severe thiamine deficiency. The patient's thiamine level was low. The patient was started on i.v. thiamine and slowly began to recover. CONCLUSION: Cerebral beriberi, more commonly known as Wernicke's encephalopathy, is a difficult diagnosis to make in the ED. A thorough neurologic examination is difficult to perform in the ED environment, but it is necessary when trying to determine the etiology of the patient's altered mental status. The number of patients with Wernicke's encephalopathy may increase with bariatric surgery becoming more common. This disease can present with a wide variety of findings, and the classic triad is not very common. With this in mind, the physician should have a low threshold for administering thiamine intravenously. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/19406605/Wernicke's_encephalopathy_presenting_as_acute_psychosis_after_gastric_bypass_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(09)00195-4 DB - PRIME DP - Unbound Medicine ER -