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Encéphalopathie de Gayet-Wernicke et anorexie mentale, présentation clinique particulière chez un adolescent.

par Goban, Vildan ;François, A;Chaouat, Philippe ;Cogan, N;Guissard, Gretel ;Deconinck, Nicolas
Référence Neuropsychiatrie de l'enfance et de l'adolescence, 59, page (428-432)
Publication Publié, 2011

Article révisé par les pairs

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Résumé :

Gayet-Wernicke's encephalopathy is a neurological condition caused by a deficit in vitamin B1, occurring most frequently in alcoholic patients. Although rare, its description is also known in the pediatric population where it is often associated with cancers, gastrointestinal chronic malabsorption disorders, and has also been reported with teenagers suffering from malnutrition exhibiting particular psychiatric diseases. The diagnosis of Gayet-Wernicke's encephalopathy is mainly clinical and is characterized by the triad of mental confusion, occulomotor disorders and ataxia. Treatment consists of vitamin B1 infusion and is generally associated with a good prognosis if the diagnosis is made on time. We report the original observation of a 14-year-old male patient. He was admitted in the child psychiatry unit in the context of anorexia nervosa associated with anxiety disorders. He had been presenting important weight loss and malnutrition for the last eight months. This patient's clinical symptoms consisted of acute anxiety, mental slowness and a progressive confusion that were initially attributed to a psychiatric condition. After the administration of a glucose infusion, the patient developed severe ataxia and a multidirectional nystagmus making the diagnosis of Gayet-Werncike encephalopathy highly probable. Gayet-Wernicke was indeed confirmed by typical ophtalmological and brain MRI findings together with a low blood cell transketolase activity. Symptoms drastically improved after high doses of vitamin B1 infusion. Our case illustrates the importance of timely identification of Gayet-Wernicke encephalopathy in young psychiatric patients particularly when associated with eating disorders. Early vitamin B1 supplementation should be initiated quite early in the diagnosis process to avoid long-term sequels in this young age population. © 2011 Elsevier Masson SAS.