A case of Wernicke encephalopathy arising in the early stage after the start of hemodialysis

Wernicke encephalopathy (WE) resulting from vitamin B1 (VB1) deficiency is commonly regarded as being associated with a high alcohol intake; however, recently many non-alcohol-related cases have been reported. Herein, we report a case of WE due to VB1 deficiency in the early stage after the start of hemodialysis. The patient was a 79-year-old male recommended for hemodialysis due to chronic renal failure. He was admitted to our hospital due to a hemorrhagic duodenal ulcer, but hemodialysis was started as the result of exacerbation of renal function. After the start of 3-times-weekly hemodialysis, the patient’s general condition was settled and he was able to consume about half his usual dietary intake. Seventeen days after the start of hemodialysis, impaired consciousness and involuntary movements appeared, and subsequent head magnetic resonance imaging showed increased signal intensity around the cerebral aqueduct. VB1 administration based on a suspicion of WE resulted in a significant improvement in neurological symptoms and no sequelae were observed. Hemodialysis may be a risk factor for VB1 deficiency. When a dialysis patient presents with psychiatric symptoms or impaired consciousness, in particular, it is important to always keep the possibility of VB1 deficiency in mind.