A case of Wernicke’s enkephalopathy associated with disulfiram intoxication.

A case of association of Wernicke’s encephalopathy (WE) with disulfiram intoxication is reported. Features of onset, clinical findings and brain magnetic resonance imaging (MRI) abnormalities are described, and compared to previous reports in the literature. Background There are several reports on disulfiram intoxication, but little evidence of neurological conditions resulting from the combination of Wernicke’s encephalopathy (WE)-associated brain lesions and disulfiram-induced damage. Material and methods A 50-year old woman with a history of chronic alcohol abuse, who was taking disulfiram, presented with an acute confusional state, dysarthria, nystagmus, supranuclear ophthalmoplegia and paraparesis. Results Biochemical serum and CSF analysis were all normal. A motor polineuropathy was detected by EMG. Cognitive assessment revealed severe impairment of memory, attention, logical and executive abilities. MRI with gadolinium showed brain lesions consistent with WE, but also symmetrical hyperintensities on T2-weighted images in the globus pallidus. Treatment with hydratation, high doses thiamine supplementation and benzodiazepines was started, leading to a significant improvement of consciousness and ocular motricity. An MRI investigation after one month of treatment revealed complete disappearance of the lesions, also in the globus pallidus. After a further month of intensive neurorehabilitation, the patient was able to interact with the medical staff and the neuropsychological test showed only mild memory impairment. Conclusions The possibility of an incorrect diagnosis is high in alcoholic patients presenting at emergency departments, especially since there is no specific routine laboratory test for detecting disulfiram intoxication, when asymptomatic. Although uncommon, this association should be borne in mind in these patients, and can be detected through early correct clinical and anamnestic evaluation together with characteristic MRI findings