Abstract
The patient was a 74-year-old woman with chronic renal failure being treated conservatively. The cause of renal failure might be renal sclerosis. She had complained of nausea and anorexia since October 2007. She was admitted to Handa City Hospital due to the progression of renal failure on October 23, 2007. On admission, serum levels of blood urea nitorogen (BUN), creatinine (Cr), and bicarbonate (HCO3-) were 64.1mg/dL, 5.14mg/dL, and 13.2mmol/L, respectively. There was no abdominal pain and no signs of severe lesion on abdominal ultrasonograph. Only chronic gastritis was detected in the endoscopy. Her serum levels of BUN and Cr were elevated to 80.4mg/dL and 6.38mg/dL on the third day after admission. Hemodialysis was started for uremia on the fourth day. However, her complaint did not improve and poor sight and unclearness appeared. Consciousness gradually became somnolent, so magnetic resonance imaging (MRI) of the brain was performed on the 8th day. T2, FLAIR, and diffusion-weighted MRI showed high-signal-intensity areas in the periaqueduct, over the mamillary bodies, and inside the thalamus, which was a characteristic finding of Wernicke's encephalopathy. Thiamine treatment was immediately initiated, and consciousness promptly improved. Later, a low plasma thiamine level of 14ng/mL (normal range 20-50 ng/mL) was demonstrated. She was treated with regular hemodialysis and rehabilitation, then transferred to another hospital for rehabilitation on the 57th day. The cause of Wernicke's encephalopathy was considered to be in adequate nutrition due to diet therapy and uremia, coupled with the loss of water-soluble vitamins during the dialysis procedure.
