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A nerve conduction study showed severe length-dependent axonal sensorimotor polyneuropathy. This was a diagnostic dilemma until an MRI brain revealed symmetrical signal abnormality and enhancement in the periaqueductal area indicative of Wernicke\u2019s encephalopathy, caused by thiamine deficiency from poor nutrition. Beriberi, also caused by thiamine deficiency, accounted for his tachycardia, polyneuropathy, areflexia, hypothermia and biochemical abnormalities. Both beriberi and Wernicke\u2019s encephalopathy are medical emergencies, which were treated with intravenous thiamine to good effect.<\/jats:p>","DOI":"10.1136\/bcr-2018-227412","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T05:16:22Z","timestamp":1546578982000},"page":"e227412","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Starvation-induced diplopia and weakness: a case of beriberi and Wernicke\u2019s encephalopathy"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5938-2304","authenticated-orcid":false,"given":"Timothy Xin Zhong","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kheng Choon","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Chan Chung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Than","family":"Aung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,3]]},"reference":[{"key":"2025082702415575000_12.1.e227412.1","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.1"},{"key":"2025082702415575000_12.1.e227412.2","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nuv107"},{"key":"2025082702415575000_12.1.e227412.3","doi-asserted-by":"crossref","first-page":"1090.2","DOI":"10.1212\/01.wnl.0000471972.90236.b6","article-title":"Clinicopathologic features of folate-deficiency neuropathy","volume":"85","author":"Sechi","year":"2015","journal-title":"Neurology"},{"key":"2025082702415575000_12.1.e227412.4","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1055\/s-0035-1558975","article-title":"Myasthenia Gravis","volume":"35","author":"Gwathmey","year":"2015","journal-title":"Semin Neurol"},{"key":"2025082702415575000_12.1.e227412.5","doi-asserted-by":"crossref","unstructured":"Yousuf UA , Yashodhara BM , Thanigasalam T , et al . 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