We describe a case of rapidly progressive and seriously debilitating polyneuropathy in a patient with confirmed Hypovitaminosis B1, accordance with dry beriberi. The decisive factor was this is a treatable condition, although sometimes incomplete recovery, but it is probably under recognized yet increasingly faced with the increasing number of alcohol abuse in the Western world.
A 49-year-old Caucasian British man presented with progressive weakness of the lower extremities of about seven months duration. He known difficulty climbing stairs. He complained of also lethargy and the loss of muscle bulk, including his thighs. He had refused a history of type 2 approved but excessive alcohol consumption diabetes mellitus and previous alcohol abuse in the five years before the presentation. First clinical and Neurophysiological investigations were consistent with a mild peripheral neuropathy and probably proximal myopathy. However, in the subsequent four months he developed a marked quadriplegia with profound sensory disturbance of all players. Repeat neurophysiology revealed a widespread polyneuropathy with extensive acute and subacute denervation changes in all four limbs, and reduced or sensory nerves Aktionspotentiale absent. Malnutrition B1 has been confirmed (45nmol/L, reference area 66-200nmol/L). His rapid clinical deterioration was in accordance with dry beriberi. He was treated with thiamin. Subsequent follow-up but significant improvement revealed slowly, so by 15-16 months from the first onset of symptoms, and six months after the beginning of his marked quadriplegia, he was able, to stand independently and trust was gradually in walking up to a period of stationary Neurorehabilitation.
There is a potentially wide differential diagnosis for this type of presentation. Confirm Hypovitaminosis B1 by request of the assay before vitamin replacement guarantees accurate diagnosis and appropriate ongoing treatment. An increasingly high index is probably suspected in connection with the increasing number of alcohol abuse in the Western world and the increasing prevalence of dry beriberi possible needed.
