Abstract
An 82-year-old male patient with nephrosclerosis had been under maintenance hemodialysis therapy for 10 years when he developed disturbed consciousness. Prior to developing this symptom, the patient had noticed loss of appetite and vertigo for about 3-4 weeks. During the period of observation at an outpatient clinic, the symptoms became worse. About 1 month after the onset of the symptoms, the patient was admitted to our hospital. Magnetic resonance imaging (MRI) showed typical abnormal lesions in the periaqueduct, third periventricle, and over the mammillary bodies, and Wernicke's encephalopathy was diagnosed. In addition, the patient's serum thiamine level was extremely low (10.5 ng/mL). He was immediately treated by intravenous thiamine administration, which resulted in significant improvement. However, thiamine deficiency is often seen in dialysis patients because of dietary restrictions as well as loss of the vitamin during dialysis. Wernicke's encephalopathy is a life-threatening disease, and early detection and prompt treatment are important for recovery. We emphasize that Wernicke's encephalopathy, though a rare complication, should be suspected in all patients on HD who present with altered mental status or confusion.
