Non-Alcoholic Wernicke-Korsakoff Syndrome After a Whipple Procedure: Delayed Recognition, Neuropsychological Findings, and Rehabilitation Follow-Up: A Case Report.

Abstract

Background and Clinical Significance: Wernicke encephalopathy (WE) is a potentially reversible neurological emergency caused by thiamine deficiency. Although classically associated with alcohol use, it may also occur after gastrointestinal surgery and prolonged nutritional compromise, where diagnosis can be obscured by postoperative delirium or metabolic encephalopathy. Case Presentation: A 58-year-old woman with no history of alcohol use underwent a Whipple procedure for pancreatic head adenocarcinoma. Her postoperative course included an anastomotic leak, prolonged open-abdomen management, severely restricted oral intake, and long-term total parenteral nutrition. Approximately 1.5 months after surgery, she developed fluctuating confusion, visual hallucinations, marked recent-memory impairment, diplopia, nystagmus, and gait ataxia, initially interpreted as postoperative delirium/metabolic encephalopathy. Approximately two years later, persistent anterograde amnesia, cerebellar and oculomotor findings, and neuropsychological deficits in attention, memory, and executive functions led to clinical suspicion of previous WE. Re-evaluation of the acute MRI showed bilateral medial thalamic and periaqueductal FLAIR hyperintensities that were absent on follow-up imaging, supporting the retrospective diagnosis; the persistent amnestic syndrome was compatible with Korsakoff syndrome. B-complex vitamin supplementation was initiated, followed by 10 weekly 60 min cognitive rehabilitation sessions and a family-supported home program. Family members reported improved retention of recent information and greater daily independence, but formal post-treatment neuropsychological reassessment could not be completed. Conclusions: This case highlights the difficulty of recognizing non-alcoholic WE during a complicated postoperative course. The observed functional changes cannot be attributed specifically to rehabilitation because vitamin supplementation, nutritional recovery, spontaneous recovery, and rehabilitation occurred within the same follow-up period.