Thiamine refractory Wernickes encephalopathy reversed with magnesium therapy

Description

A 34-year-old man was presented to our emergency department in alcohol withdrawal.

Despite initial treatment with high-dose intravenous thiamine therapy he went on to develop nystagmus (video 1), ataxia, pass pointing, intention tremor and worsening confusion. He was diagnosed with Wernickes encephalopathy, an acute neuropsychiatric syndrome resulting from thiamine deficiency.1

Video 1

Our patient demonstrates bilateral vertically upbeat nystagmus.

His serum magnesium levels were found to be low at 0.41 mmol/L (normal range 0.66–1.02 mmol/L). He was started on high-dose intravenous magnesium in addition to thiamine replacement and his neurological symptoms resolved once his serum magnesium levels had normalised (video 2).

Video 2

Our patient's nystagmus has improved, although a few beats remain at extreme lateral gaze.

He was discharged home and on review in clinic 4 weeks later, he had made a complete recovery.

Magnesium is an...

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