Non-alcoholic Wernicke Encephalopathy During Orthopedic Rehabilitation in a Patient Following Total Gastrectomy: A Case Report

An 82-year-old woman, who had undergone total gastrectomy for gastric cancer 22 years earlier, fell at home three months prior and underwent surgical repair for a femoral neck fracture. She had been receiving rehabilitation at a convalescent hospital. One week before presentation to our hospital, she experienced another fall, after which she developed decreased oral intake, generalized weakness, and altered mental status. Due to these worsening symptoms, she was transferred from the rehabilitation hospital to our facility. After admission, brain magnetic resonance imaging was performed, which revealed high-signal intensities around the midbrain aqueduct and bilateral medial thalami on FLAIR imaging, leading to a diagnosis of Wernicke encephalopathy (WE). Her serum thiamine level was markedly low at 1.2 μg/dL. Although she had no history of alcohol use, WE was strongly suspected. Her mental status improved with intravenous thiamine administration and infusion therapy for dehydration. Two weeks later, she was transferred back to a rehabilitation facility for continued care. In this case, chronic thiamine malabsorption due to prior total gastrectomy was the underlying condition, and acute nutritional deficiency from poor oral intake over the preceding week likely triggered the onset of WE in a patient with depleted thiamine stores. This case underscores the importance of considering WE in elderly patients with risk factors such as gastrointestinal surgery, even in the absence of alcohol consumption.