Wernicke encephalopathy following advanced caecum cancer

A 26-year-old lactating mother presented with a 3-week history of abdominal pain, constipation and vomiting. She denied a history of alcohol abuse or other gastrointestinal problem. Contrast-enhanced CT revealed a small bowel obstruction caused by caecum cancer. Therefore, she underwent a right hemicolectomy and ileocolic anastomosis. Post-operatively, she gradually developed drowsiness, fainting and a rapid heart rate of 130. But blood tests were all normal. On the fourteenth postoperative day, she experienced two episodes of generalized tonic-clonic seizure. Neurologic examination revealed nystagmus, ophthalmoplegia and gait ataxia. She complained of impaired memory and blurred vision. Brain magnetic resonance image (MRI) showed bilaterally symmetric hyperintensities in paramedial thalami surrounding the third ventricle, dorsal brainstem and periaqueductal region in the axial T2-FLAIR images . Wernicke's encephalopathy (WE) was suspected and the patient was treated with Vitamin B1 immediately. Her symptoms improved rapidly, and a brain MRI two weeks later demonstrated marked resolution of the hyperintensities.