Abstract
A 66-year-old male with habitual alcohol drink complained acute
deterioration of left-side muscle weakness as initial presentation. On
the arrival, the patient was confused, with stable vital sign and
unremarkable pyramidal sign. Although several potential diagnoses could
be considered, brain computed tomography did not provide diagnostic
information, and subsequently-performed magnetic resonance imaging
revealed hyperintense lesions on T2-flair images in corpus callosum,
suggesting MBD as clinical diagnosis. Prompt diagnosis enabled us to
introduce thiamine administration with subsequent favorable neurological
outcome.
CASE
A 66-year-old male with habitual alcohol drink complained acute
deterioration of left-side muscle weakness as initial presentation. On
the arrival, the patient was confused, with stable vital sign (blood
pressure 141/96mmHg, pulse rate 99/min, body temperature 37.2 ℃) and
unremarkable pyramidal sign. Body mass index was 19.5 kg/m2 and
decreased skin turgor suggested moderate dehydration. Although several
potential diagnoses could be considered, brain computed tomography did
not show any diagnostic information, other than ambiguous low-density
area along with corpus callosum. We subsequently performed magnetic
resonance imaging and found hyperintense lesions of both corpus callosum
on T2-flair images and splenium on diffusion-weighted images (Figure),
suggesting MBD as clinical diagnosis. The patient was treated initially
with intravenous infusion including vitamin B1, and switched to its oral
supplementation along with alcohol cessation. In response to the
treatment, consciousness disturbance had been much improved within 12
hours after the thiamine supplementation, and no neurological deficit
remains after 10 days hospital stay.