Deep Cerebral Venous Sinus Thrombosis in an Alcohol Dependent Male: An Important Differential for Wernicke’s Encephalopathy

Abstract

Wernicke’s encephalopathy (WE) is suspected in patients with chronic alcoholism with poor nutrition presenting with walking difficulty, ocular problems and fluctuating orientation. However, one must quickly consider other possibilities if typical radiological features are absent or unexplained symptoms are present. A man in his mid-40s with an alcohol intake of ten years presented with walking difficulty, nystagmus, bilateral lateral rectus palsy and fluctuating orientation for ten days, along with deficits in recent memory. He had a history of poor nutrition for three months, diarrhoea for one month, and severe diffuse headache and slurred speech for ten days. Plain MRI-Brain revealed an acute non-haemorrhagic left thalamic infarct and chronic infarct/early gliosis in the left cerebellar hemisphere and left temporal lobe. Contrast-enhanced MR-Venography revealed cerebral venous sinus thrombosis. The patient showed rapid improvement with high-dose parenteral thiamine and low molecular weight heparin and is currently maintaining well on 3 milligrams of warfarin.