An Autopsy Case of Acute and Nonalcoholic Thiamine-Deficient Encephalopathy

unwitnessed interval by family was approx-imately 1 day, and the patient did not have a habit of drinking alcohol. A medicolegal autopsy revealed severe pyloric stenosis with dilatation of the stom-ach ( fig. 1 a, b). Histologic examination showed proliferation and invasion of atyp-ical cells with glandular formation, sugges-tive of moderately differentiated adenocar-cinoma ( fig. 1 c). Metastasis of tumor cells was seen in many of the circumferential lymph nodes, but not in other organs. Be-cause of the amount of gastric contents fill-ing the upper airway, the direct cause of death was considered to be asphyxia due to aspiration. There was also a small abscess in the right upper lung lobe.The brain weighed 1,350 g and, macro- scopically, no significant atrophy was seen in the cerebrum, cerebellum, or brain stem. On coronal sections of the cerebrum, bilat-eral mammillary bodies showed petechial and local hemorrhage without obvious brown discoloration and atrophy ( fig. 2 a). The third ventricle was mildly dilated, and the folia of the superior vermis and dorso-medial portion of the cerebellar hemi-spheres were not atrophic ( fig. 2 b). On light microscopy, fresh petechial hemorrhages were prominent with some foci of proliferation of immature small Dear Sir, Thiamine deficiency can cause a severe neurological disorder known as Wer-nicke’s encephalopathy (WE). While this encephalopathy is considered common in alcoholics [1], only a small number of non- alcoholic cases have been reported [2–5] . The important pathological and radiologi-cal features of thiamine-deficient encepha-lopathy are the selective vulnerability of specific brain regions to pathologic chang-es [6] . We report a case of autopsy-proven acute nonalcoholic thiamine-deficient en-cephalopathy without medical treatment antemortem.