Wernicke's encephalopathy in a child with Down syndrome, undergoing treatment for acute lymphoblastic leukemia
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Wernicke's encephalopathy (WE), the early diagnosis of which is crucial to prevent permanent sequelae, is an acute neurologic disorder that develops due to thiamine deficiency, and which is associated with considerable morbidity and mortality. A 10-year-old boy diagnosed with Down syndrome and acute lymphoblastic leukemia had severe vomiting and impaired consciousness following methotrexate treatment at a dose of 1 g/m(2). Biochemistry was consistent with the syndrome of inappropriate anti-diuretic hormone secretion. Level of consciousness did not improve following meticulous correction of hyponatremia, therefore cranial magnetic resonance imaging was done, which indicated specific findings consistent with WE. It should be kept in mind that Down syndrome patients are more likely to incur toxic side-effects of chemotherapeutic agents, and thus neurological complications such as WE may occur.