{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T22:00:13Z","timestamp":1785708013140,"version":"3.56.0"},"reference-count":10,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T00:00:00Z","timestamp":1652400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Objectives: a stroke-like lesion, the morphological equivalent of a stroke-like episode and the hallmark of mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome, have not been reported as manifestations of thiamine deficiency. Case report: a 62-year-old man with a history of chronic alcoholism was admitted after a series of epileptic seizures. Upon waking up from the coma, he presented with disorientation, confusion, confabulation, psychomotor agitation, aggressiveness, right hemianopsia, aphasia, and right hemineglect over weeks. Electroencephalography showed a questionable focal status epilepticus over the left hemisphere, responsive to lorazepam and oxcarbazepine. Follow-up electroencephalographies no longer recorded epileptiform discharges. Cerebral magnetic resonance imaging (MRI) revealed T2-\/diffusion weighted imaging (DWI) hyperintensity in the left occipito-temporal region that was not congruent to a vascular territory which persisted for at least nine weeks. Since a lactate-peak could be seen in this lesion by magnetic resonance-spectroscopy, this was interpreted as a stroke-like lesion. Since thiamine was reduced, the stroke-like lesion was attributed to thiamine deficiency after the exclusion of differential diseases, including MELAS and status epilepticus. The patient\u2019s behavioural and cognitive dysfunctions largely resolved upon vitamin-B1 substitution. Conclusions: the case suggests that thiamine deficiency presumably causes mitochondrial dysfunction with cerebrospinal fluid lactic acidosis and a stroke-like lesion mimicking MELAS syndrome. It should be further studied whether nutritional deficits, such as thiamine deficiency, could give rise to secondary stroke-like lesions.<\/jats:p>","DOI":"10.3390\/medicina58050660","type":"journal-article","created":{"date-parts":[[2022,5,14]],"date-time":"2022-05-14T09:27:56Z","timestamp":1652520476000},"page":"660","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Wernicke Encephalopathy Mimicking MELAS"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2839-7305","authenticated-orcid":false,"given":"Josef","family":"Finsterer","sequence":"first","affiliation":[{"name":"Neurology & Neurophysiology Center, Postfach 20, 1180 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s11604-020-00989-3","article-title":"Comprehensive review of Wernicke encephalopathy: Pathophysiology, clinical symptoms and imaging findings","volume":"38","author":"Ota","year":"2020","journal-title":"Jpn. J. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e227731","DOI":"10.1136\/bcr-2018-227731","article-title":"Non-alcoholic Wernicke encephalopathy: Great masquerader","volume":"11","author":"Okafor","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1136\/jnnp.49.4.341","article-title":"Clinical signs in the Wernicke-Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy","volume":"49","author":"Harper","year":"1986","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1212\/CPJ.0b013e3182a1ba00","article-title":"Brain MRI findings in Wernicke encephalopathy","volume":"3","author":"Wicklund","year":"2013","journal-title":"Neurol. Clin. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/0960-8966(92)90045-8","article-title":"Melas: An original case and clinical criteria for diagnosis","volume":"2","author":"Hirano","year":"1992","journal-title":"Neuromuscul. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.bbagen.2011.03.015","article-title":"MELAS: A nationwide prospective cohort study of 96 patients in Japan","volume":"1820","author":"Yatsuga","year":"2012","journal-title":"Biochim. Biophys. Acta."},{"key":"ref_7","unstructured":"Adam, M.P., Ardinger, H.H., Pagon, R.A., Wallace, S.E., Bean, L.J.H., Gripp, K.W., Mirzaa, G.M., and Amemiya, A. (2018). MELAS. 27 February 2001 [updated 29 November 2018]. GeneReviews\u00ae [Internet], University of Washington, Seattle."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0925-4927(01)00304-3","article-title":"Serial MRI and (1)H-MRS of Wernicke\u2019s encephalopathy: Report of a case with remarkable cerebellar lesions on MRI","volume":"108","author":"Murata","year":"2001","journal-title":"Psychiatry Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.4103\/0028-3886.266252","article-title":"Pathophysiological Evaluation in a Case of Wernicke\u2019s Encephalopathy by Multimodal MRI","volume":"67","author":"Lyu","year":"2019","journal-title":"Neurol. India"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1007\/s00134-002-1436-x","article-title":"Acute lactic acidosis with Wernicke\u2019s encephalopathy due to acute thiamine deficiency","volume":"28","author":"Chadda","year":"2002","journal-title":"Intensive Care Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/5\/660\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:10:31Z","timestamp":1760137831000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/5\/660"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,13]]},"references-count":10,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["medicina58050660"],"URL":"https:\/\/doi.org\/10.3390\/medicina58050660","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,13]]}}}