Heavy Cannabis Use Associated with Wernicke's Encephalopathy.

Cannabis use accounts for more than 149,000 hospital visits annually. As more states legalize recreational Cannabis, side effects that are currently rare or unknown will become increasingly more common. Here, we present one such rare case of Cannabis-induced hyperemesis causing Wernicke's encephalopathy. This is an investigational case report utilizing retrospective data from electronic medical records. A 41-year-old patient presented to the hospital in status epilepticus secondary to severe vomiting and hyponatremia. He was given one dose of thiamine, glucose and folate and admitted to the medical ICU. His history was significant for remote alcohol use (1-2 beers/week about 20 years ago) and heavy marijuana use from strains grown in the patient's own backyard. A diagnosis of Cannabis Hyperemesis Syndrome was made. Seizures resolved after correction of electrolytes, and he became awake and alert with no focal deficits. His neurological exam after he was clinically stable showed memory deficits including confabulations (e.g., incorrectly listing occupation) and delusions (e.g., praying to a queen bee). An extensive workup including routine laboratory testing, infectious panels, and autoimmune studies was entirely negative. On the day of admission, brain magnetic resonance imaging (MRI) was performed showing bilateral thalamic hyperintensities on T2 FLAIR MRI. Wernicke's encephalopathy (WE) remained most likely and intravenous thiamine led to a gradual improvement in the patient's symptoms. He is now two months into rehabilitation and continues to make progress in recalling life events. Alcohol abuse is empirically treated with thiamine whereas Cannabis, unlike alcohol, is presumed to induce hyperphagia and nutritional supplements are often not initiated. However, foods ingested by Cannabis users are nutritionally deficient due to underline malabsorption. In addition, Cannabis-induced vomiting can further cause malnutrition. Complications, like Wernicke's encephalopathy, can be prevented by supplementing thiamine early in Cannabis intoxication.