Wernicke’s Encephalopathy as Unexpected Cause of Vertigo for Otolaryngologist – A Case Report

<b>Introduction:</b> Vertigo is one of the most common presentations, especially for the elderly. Often it represents a challenging diagnosis since the symptoms and signs are frequently vague. The causes of vertigo are diverse, and the possible differential diagnosis is extensive. Thiamine deficiency after sleeve gastrectomy is one of the rare causes of vertigo, a condition called Wernicke’s encephalopathy. Video-Nystagmography (VNG) is among the audiological diagnostic tools for vertigo.<b>Case report:</b> This is a case report of a 20-year-old female complaining of continuous vertigo for 2 months. She described vertigo as a spinning sensation that worsened with head movements, especially to the left side. Other symptoms included eyes, lower limbs, and gastrointestinal tract. She underwent sleeve gastrectomy prior to the onset of dizziness. On examination, she was conscious but confused. She had difficulty focusing on questions. Eye movement examination revealed horizontal and vertical nystagmus. She displayed signs of ataxia. Pure tone audiometry revealed mild low-frequency sensorineural hearing loss with low compliance on tympanometry. VNG revealed upbeating nystagmus in primary gaze, leftward gaze, and upward gaze when vision is accessible, and in upward gaze when vision is denied suggesting a central etiology. Investigations: Vitamin D: 7.44 ng/ml, vitamin B1: 1.0 ng/ml (2.5–7.5). Laboratory tests confirmed low serum thiamine and vitamin D levels. Low thiamine raises the suspicion of Wernicke’s encephalopathy. Within 72 hours of treatment, vertigo and ataxia began to improve, and the nystagmus reduced significantly. Over the next few days, her balance and coordination greatly improved, as well as her mental state.<b>Conclusions:</b> This case underscores the significance of considering Wernicke's encephalopathy in the differential diagnosis of vertigo, especially in patients with a history of bariatric surgery, regardless of age. It also emphasizes the need for prompt thiamine supplementation in such cases, as timely intervention along with supportive treatments can significantly improve patient outcomes. Otolaryngologists should maintain a broad perspective when diagnosing vertigo to ensure accurate and effective treatment.