Abstract
Thiamine (vitamin B1) deficiency, typically associated with severe alcohol use disorder, can result in severe neurological dysfunction. We present the case of a 60-year-old woman with no significant past medical history or alcohol use who, over a 6-month period, developed progressive abdominal distension, and early satiety. This was managed by progressive elimination of different foods until her diet consisted of water and peppermint tea. Admission to hospital was precipitated by acute onset altered mental status, diplopia, and gait disturbance.
Examination revealed disorientation, abdominal distension without shifting dullness or peritonism, a bilateral internuclear ophthalmoplegia, impaired vertical gaze, and proximal weakness. Blood testing revealed an undetectable serum vitamin B1 and low folate. MRI imaging supported diagnoses of Wernicke’s encephalopathy and a large adnexal mass was identified on CT imaging of the abdomen.
Treatment with high-dose intravenous thiamine and gradual refeeding via nasogastric tube led to rapid improvement in confusion and ophthalmoplegia, but proximal myopathy and ataxia improved over weeks. Histopathology identified the mass as a mucinous cystadenoma. The patient was discharged requiring walking aids. This case underscores the critical role of thiamine in neurological function, emphasizing the potential for severe deficiency effects due to dietary restrictions even in the absence of alcohol consumption.
