Non-alcoholic Wernicke's encephalopathy - Unusual clinical findings

Wernicke's encephalopathy is a common complication of thiamine deficiency among alcoholics. However, there are few reports of this disorder in non-alcoholics. We present a case of Wernicke's encephalopathy in a non-alcoholic, 68-year-old patient with recurrent vomiting attributed to biliary colics. Establishing the diagnosis in this patient was complicated by our finding of positive 14-3-3 protein in the cerebrospinal fluid (CSF). This is typically elevated in prion disease, but it has not previously been reported to be elevated in this entity. Compatible clinical presentation in combination with typical magnetic resonance imaging (MRI) findings and exclusion of other possible causes finally established the diagnosis.