Wernicke encephalopathy revealing occult gastric adenocarcinoma: Radiological and clinical insights

Wernicke's encephalopathy (WE) is an acute neuropsychiatric disorder caused by thiamine deficiency, often underdiagnosed in non-alcoholic patients. We report a rare case of Wernicke encephalopathy in a 60-year-old male presenting with diplopia, dizziness, and gait instability secondary to prolonged vomiting and malnutrition. Contrast-enhanced thoracoabdominal CT revealed irregular wall thickening of the antropyloric region of the stomach with heterogeneous soft-tissue density and multiple hepatic hypodense lesions showing peripheral enhancement, consistent with metastatic spread. Brain MRI demonstrated symmetric FLAIR hyperintensities involving the medial thalami, mammillary bodies, and periaqueductal gray matter, without diffusion restriction, consistent with Wernicke encephalopathy. Lesions measured 3mm in the mammillary bodies. Prompt administration of thiamine led to rapid clinical improvement. This case is notable as occult gastric cancer presented primarily through neurological symptoms of WE, highlighting the importance of considering neoplastic causes in non-alcoholic presentations.