title: Wernicke encephalopathy due to thiamine deficiency after surgery on a child with duodenal stenosis.
abstract: BACKGROUND
  Wernicke encephalopathy is rare in children and is caused by thiamine deficiency. It is characterized by acute or subacute ataxia, altered consciousness, and ophthalmoparesis. Gastroenterological surgery, total parenteral nutrition for short bowel syndrome, and alcoholism are common risk factors for Wernicke encephalopathy. Typical magnetic resonance imaging features include selective symmetrical signal changes in the mammillary bodies, medial thalamus, tectum, periaqueductal region, cranial nerves, cerebellum, red nucleus, dentate nucleus, fornix, splenium, cerebral cortex, and putamen. If left undiagnosed and untreated, the disease may be fatal.
  
  
  METHODS
  We describe a 13-year-old boy who developed acute cerebellar findings while receiving total parenteral nutrition after gastroduodenostomy for duodenal stenosis.
  
  
  RESULTS
  The diagnosis of Wernicke encephalopathy was based on his clinical history, neurological examination, and imaging results. We immediately started intravenous thiamine replacement therapy. Two weeks later, the patient's clinical signs had resolved except for mild clumsiness, which was observed during his tandem gait examination.
  
  
  CONCLUSIONS
  Our report emphasizes the importance of clinical and magnetic resonance imaging pattern recognition in timely diagnosis, as well as the importance of prompt thiamine replacement therapy. We also demonstrate the importance of thiamine supplementation during total parenteral nutrition after gastrointestinal surgery.
authors.affiliation: Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey. Electronic address: elifacararslan@yahoo.com.tr.
authors.forename: Elif Acar
authors.initials: EA
authors.lastname: Arslan
authors.affiliation: Department of Pediatric Surgery, Hacettepe University Children's Hospital, Ankara, Turkey.
authors.forename: Saniye
authors.initials: S
authors.lastname: Ekinci
authors.affiliation: Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey.
authors.forename: Pınar Zengin
authors.initials: PZ
authors.lastname: Akkuş
authors.affiliation: Department of Radiology, Hacettepe University, Ankara, Turkey.
authors.forename: Rahşan
authors.initials: R
authors.lastname: Göçmen
authors.affiliation: Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey.
authors.forename: Göknur
authors.initials: G
authors.lastname: Haliloğlu
mesh_terms: D000293:Adolescent; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004380:Duodenal Obstruction / Q000601:surgery*; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D007409:Intestinal Atresia; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D013831:Thiamine / Q000008:administration & dosage / Q000494:pharmacology; D013832:Thiamine Deficiency / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000494:pharmacology; D014899:Wernicke Encephalopathy / Q000188:drug therapy / Q000209:etiology*
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine
keywords: MRI; Wernicke encephalopathy; children; gastroenterological surgery; magnetic resonance imaging; ophthalmoplegia; thiamine deficiency