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Intravenous thiamine led to rapid, dramatic recovery, highlighting a rare non-alcohol-related WE presentation precipitated by thiamine deficiency from Cannabis Hyperemesis Syndrome.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/wernickes-encephalopathy-secondary-to-cannabis-hyperemesis-syndrome/420570/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/wernickes-encephalopathy-secondary-to-cannabis-hyperemesis-syndrome/420570.png","ImageObject",300,407,{"name":42,"@type":43},"pixelkiddo","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What 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Secondary to Cannabis Hyperemesis Syndrome  \nLakshmi Kattamuri, MD1, Sidhartha Gautam Senapati, MD1, Harshitha Popuri, MD1, Lorena Fernandez, BSA2, Kunal Sharma, MD1, Srija Sirineni, MBBS3, Sparsha Reddy Duvvuru, MD1, Abhinav Vulisha, MD1  \n1 Department of Internal Medicine, Texas Tech University Health Science Center El Paso,  \n2 Texas Tech University Health Science Center El Paso,  \n3 Bhaskar Medical College  \nJournal of Brown Hospital Medicine Vol. 5, Issue 1, 2025  \nArticle Information  \nKeywords: Encephalopathy, cannabis, Cannabis hyperemesis syndrome, thiamine deficiency, Wernicke encephalopathy  \n[https://doi.org/10.56305/001c.151455](https://doi.org/10.56305/001c.151455)  \nSubmitted: October 15, 2025 EST  \nAccepted: November 30, 2025 EST  \nPublished: January 01, 2026 EST  \nAbstract  \nA woman in her 20s presented with an 8-week history of nausea and vomiting. She reported poor appetite and unintentional weight loss of more than 10 kg of her body mass. Two weeks before admission, she developed double vision followed by unsteady gait and confusion. Neurological examination revealed bilateral lateral rectus palsy with horizontal nystagmus in her eyes and ataxic gait. Brain MRI revealed T2/ fluid attenuation inversion recovery (FLAIR) high signal in symmetrical thalamic hyperintensities suggestive of Wernicke’s encephalopathy (WE). The patient was given intravenous thiamine and made a rapid and dramatic recovery. Through this case, we wish to highlight a rare presentation ofWE in a non-alcoholic patient precipitated by thiamine deficiency secondary to Cannabis hyperemesis syndrome.  \nbackground  \nCannabis Hyperemesis Syndrome (CHS), a condition characterized by recurrent nausea and vomiting due to chronic cannabis use. Cannabis use by itself is not a risk factor for WE; however, chronic consumption resulting in Cannabinoid hyperemesis syndrome can precipitate thiamine deficiency, resulting in WE. It is important to note that 8.4% of the US population are cannabis users, thus making this syndrome highly relevant in clinical practice.1 Thiamine (B1) is crucial for metabolism and energy and is sourced only from the diet.2 Severe deficiency can cause Wernicke’s encephalopathy (WE), prevalent in 0.4%-2.8% of the population, with 50% linked to alcohol.2 Chronic alcohol consumption can disrupt the absorption of vitamin B1 (thiamine) in the intestinal tract, leading to alcohol-related Wernicke’s encephalopathy. Additional mechanisms contributing to thiamine deficiency in alcohol users include poor dietary intake, hepatic dysfunction reducing thiamine storage, and impaired phosphorylation of thiamine to its active form, thiamine pyrophosphate.2 However, non-alcohol related WE cases have been reported in patients with hyperemesis gravidarum, gastrointestinal and hematological cancers, bariatric surgery, malnutrition, and inflammatory bowel disease.3 Here, we discuss a case of Cannabis hyperemesis syndrome presenting with WE.  \ncase presentation  \nA 28-year-old woman presented with persistent nausea, vomiting, anorexia, and a 10 kg weight loss over two months. She had two prior hospitalizations within the past year for similar symptoms with recurrent episodes of vomiting with unrevealing workup, including laboratory tests, abdominal computed tomography (CT), and upper endoscopy. Antiemetics offered minimal relief. She reported using cannabis daily for the past year, before which she used cannabis occasionally. She denied alcohol, other illicit substance use, or chronic health conditions. The diagnosis of cannabinoid hyperemesis syndrome (CHS) was presumptive, inferred from the temporal association between escalating cannabis use and recurrent vomiting, with resolution upon cessation, in the absence of a definitive diagnostic test.  \nTwo weeks before her current hospitalization, she developed worsening double vision and, five days prior, complained of blind spots in both eyes. Her husband noted ","cbCaiu6r0UcYdlrj","https://ap.wps.com/l/cbCaiu6r0UcYdlrj","pdf",518518,"English","# Background\n## Cannabis Hyperemesis Syndrome and thiamine deficiency\n# Case Presentation\n## Initial symptoms and clinical assessment\n## Diagnostic evaluation and imaging\n# Discussion\n## Non-alcohol-related Wernicke’s encephalopathy","[{\"question\":\"What symptoms led to suspicion of Wernicke’s encephalopathy in this case?\",\"answer\":\"She developed double vision, unsteady gait, and confusion, with bilateral lateral rectus palsy and horizontal nystagmus plus ataxic gait on exam.\"},{\"question\":\"How was the diagnosis supported?\",\"answer\":\"Brain MRI showed symmetrical thalamic T2/FLAIR hyperintensities suggestive of Wernicke’s encephalopathy, while infectious and other workups were negative.\"},{\"question\":\"What treatment was given and what was the outcome?\",\"answer\":\"She received intravenous thiamine and demonstrated a rapid, dramatic recovery.\"}]","Wernicke’s Encephalopathy Secondary to Cannabis Hyperemesis Syndrome | PDF",1790621506]