Thiamine deficiency secondary to anorexia nervosa: an uncommon cause of peripheral neuropathy and Wernicke encephalopathy in adolescence

Pediatr Neurol. 2014 Jul;51(1):100-3. doi: 10.1016/j.pediatrneurol.2014.03.025. Epub 2014 Mar 30.

Abstract

Introduction: 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.

Clinical investigations: 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.

Conclusion: This patient illustrates that eating disorders can be an uncommon cause of rapidly progressive paresthesias, weakness, and neurological decline due to thiamine deficiency.

Keywords: Wernicke encephalopathy; anorexia nervosa; dry beriberi; paresthesias; peripheral polyneuropathy; thiamine.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anorexia Nervosa / complications*
  • Extremities / physiopathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Mammillary Bodies / pathology
  • Peripheral Nervous System Diseases / etiology*
  • Thiamine / blood
  • Thiamine Deficiency / complications*
  • Wernicke Encephalopathy / etiology*

Substances

  • Thiamine