• Sha Zhu, Jun Qiang, Qing Xia, Yanshu Wang, Jun Zhang, and Xianzeng Liu.
• Department of Neurology, Peking University International Hospital.
• Medicine (Baltimore). 2019 Jun 1; 98 (26): e16181e16181.

RationaleWernicke encephalopathy (WE) is a syndrome characterized by an acute or subacute onset of ataxia, ophthalmoplegia, and mental status changes. To our knowledge, hypothalamic syndrome is rare in WE.Patient ConcernsA 73-year-old female patient with acute cerebral infarct, who showed initial symptoms of vomiting, nausea, ataxia, and subsequent anorexia, was treated with parenteral nutritional supplement for 20 days. Nevertheless, the patient still developed refractory hyponatremia despite the appropriate sodium supplement given for a week following parenteral nutritional supplement. In fact, after 14 days of parenteral nutritional supplement, the patient gradually showed hypotension and apathy. Hyponatremia, hypotension, anorexia and apathy were signs of hypothalamic syndrome.DiagnosesFinally, the patient was diagnosed as WE by head magnetic resonance imaging, which showed symmetrical lesions in T2-weighted imaging images and FLAIR high signal intensity in the periaqueduct, hypothalamus, thalamus, mammiliary bodies, medulla oblongata, and vermis cerebelli.InterventionsThe patient was given thiamine supplementation.OutcomesThe patient regained consciousness within 3 days. The sings of hyponatremia, hypotension, and apathy were relieved subsequently.LessonsWhen patients develop unexplained hypothalamic syndrome, we should think of the possibility of WE. The concomitant presence of hyponatremia, hypotension, anorexia, and apathy in WE is rare. Therefore, this case is reported here for discussion.

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