Delayed Recognition of Wernicke's Encephalopathy Following the Interruption of Thiamine in an Alcohol-Dependent Patient With Status Epilepticus: A Case Report.

Wernicke's encephalopathy (WE) is an acute neurological disorder precipitated by thiamine deficiency, most commonly associated with chronic alcohol misuse. WE is underdiagnosed and can lead to significant neurological morbidity if treatment is delayed. We report the case of a 35-year-old man with alcohol dependence and a history of seizures who was admitted for the management of status epilepticus requiring intubation and intensive care. During his sedation, his regular thiamine supplementation was inadvertently withheld for four days. Following extubation and seizure stabilization, the patient developed confusion and nystagmus, raising suspicion of WE. Thiamine was promptly reinitiated empirically. Subsequent magnetic resonance imaging (MRI) revealed findings consistent with WE. The patient exhibited gradual neurological improvement with high-dose thiamine therapy and rehabilitation and was eventually discharged. This case underscores the importance of maintaining thiamine supplementation in high-risk patients and emphasizes the need to initiate treatment based on clinical suspicion rather than waiting for confirmatory neuroimaging.