title: Thiamine deficiency secondary to anorexia nervosa: an uncommon cause of peripheral neuropathy and Wernicke encephalopathy in adolescence.
abstract: BACKGROUND
  We present a developmentally appropriate adolescent boy who presented with upper and lower extremity glove-and-stocking paresthesias, distal weakness, vertigo, high-pitched voice, inattention, ataxia, and binocular diplopia after a voluntary 59-kg weight loss over 5 months.
  
  
  METHODS
  Extensive investigations revealed serum thiamine levels <2 nmol/L. Brain magnetic resonance imaging revealed symmetric abnormal T2 prolongation of the mammillary bodies. Nerve conduction studies were consistent with axonal, length-dependent polyneuropathy. Together, these findings were diagnostic for peripheral polyneuropathy and Wernicke encephalopathy secondary to thiamine deficiency.
  
  
  CONCLUSIONS
  This patient illustrates that eating disorders can be an uncommon cause of rapidly progressive paresthesias, weakness, and neurological decline due to thiamine deficiency.
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: William
authors.initials: W
authors.lastname: Renthal
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Isaac
authors.initials: I
authors.lastname: Marin-Valencia
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: patricia.evans@utsouthwestern.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Evans
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications*; D005121:Extremities / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008326:Mammillary Bodies / Q000473:pathology; D010523:Peripheral Nervous System Diseases / Q000209:etiology*; D013831:Thiamine / Q000097:blood; D013832:Thiamine Deficiency / Q000150:complications*; D014899:Wernicke Encephalopathy / Q000209:etiology*
chemical_list: D013831:Thiamine
keywords: Wernicke encephalopathy; anorexia nervosa; dry beriberi; paresthesias; peripheral polyneuropathy; thiamine