{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:12:57Z","timestamp":1791871977899,"version":"4.3.4"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>We report a case of 56-year-old man, chronic alcoholic, presented to us with progressive weakness in all the four limbs with stiffness and gait disturbance since 1-year associated with cognitive impairment. On examination he had mild confusion, spastic quadriparesis with brisk reflexes, extensor plantars and cerebellar features. During the hospital stay myoclonus was noticed in the patient, which was startle in nature. He did not have dermatitis, ascites or any stigmata of liver failure. MRI of brain revealed bilateral subdural effusion, left focal subarachnoid haemorrhage at perisylvian area and diffuse cortical atrophy. He was treated with supportive measures including thiamine with which his condition worsened. His serum niacin was low. With a possibility of alcoholic pellagra encephalopathy (APE) the patient was treated with niacin. His clinical condition improved drastically over next 1\u2005week and startle myoclonus disappeared, favouring the diagnosis of APE though multiple confounding factors were present.<\/jats:p>","DOI":"10.1136\/bcr-2013-008906","type":"journal-article","created":{"date-parts":[[2013,4,22]],"date-time":"2013-04-22T14:30:28Z","timestamp":1366641028000},"page":"bcr2013008906","source":"Crossref","is-referenced-by-count":6,"title":["A rare case of alcoholic pellagra encephalopathy with startle myoclonus and marked response to niacin therapy: time for a new dictum?"],"prefix":"10.1136","volume":"2013","author":[{"given":"Bhawna","family":"Sharma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghavendra Bakki","family":"Sannegowda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parul","family":"Dubey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swayam","family":"Prakash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,4,22]]},"reference":[{"key":"2025042707382802000_2013.apr22_1.bcr2013008906.1","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.genhosppsych.2008.04.011","article-title":"Rapid resolution of delusional parasitosis in pellagra with niacin augmentation therapy","volume":"2013","author":"Prakash","year":"2008","journal-title":"Gen Hosp Psychiatry"},{"key":"2025042707382802000_2013.apr22_1.bcr2013008906.2","first-page":"180","article-title":"Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature","volume":"2013","author":"Prousky","year":"2003","journal-title":"Altern Med Rev"},{"key":"2025042707382802000_2013.apr22_1.bcr2013008906.3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2190\/29XV-1GG1-U17K-RGJH","article-title":"Pellagra encephalopathy following B-complex vitamin treatment without niacin","volume":"2013","author":"Pitsavas","year":"2004","journal-title":"Int J Psychiatry Med"},{"issue":"Pt 4","key":"2025042707382802000_2013.apr22_1.bcr2013008906.4","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1093\/brain\/111.4.829","article-title":"The clinical spectrum of alcoholic pellagra encephalopathy: a retrospective analysis of 22 cases studied pathologically","volume":"2013","author":"Serdaru","year":"1988","journal-title":"Brain"},{"key":"2025042707382802000_2013.apr22_1.bcr2013008906.5","first-page":"1648","volume-title":"Neurology in clinical practice","volume":"vol 1","author":"Bradley","year":"2008"},{"key":"2025042707382802000_2013.apr22_1.bcr2013008906.6","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3346\/jkms.1991.6.1.87","article-title":"Alcoholic pellagra encephalopathy combined with Wernicke disease","volume":"2013","author":"Park","year":"1991","journal-title":"J Korean Med Sci"},{"key":"2025042707382802000_2013.apr22_1.bcr2013008906.7","first-page":"141","article-title":"A suspected case of alcoholic pellagra encephalopathy with marked response to niacin showing myoclonus and ataxia as chief complaints","volume":"2013","author":"Sakai","year":"2006","journal-title":"No To Shinkei"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-008906","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T14:38:39Z","timestamp":1745764719000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-008906"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,4,22]]},"references-count":7,"alternative-id":["10.1136\/bcr-2013-008906"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-008906","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,4,22]]}}}