A 15-year-old developed a serious and potentially life-threatening brain condition stemming from severe vomiting episodes linked to marijuana use, a case study reports. The condition, known as Wernicke encephalopathy (WE), was triggered by a critical deficiency in thiamine (vitamin B1), which is often exacerbated by prolonged vomiting associated with cannabinoid hyperemesis syndrome (CHS), colloquially termed 'scromiting.'
CHS is characterized by recurrent episodes of nausea, vomiting, and abdominal pain in long-term, heavy cannabis users. While marijuana is not typically considered lethal on its own, it can lead to indirect life-threatening complications. The teen's case is one of only two documented instances in adolescents where CHS has led to such a severe thiamine deficiency affecting the brain.
Medical Journey
The teen initially sought emergency room care after several days of nausea, vomiting, and headaches. He reported using cannabis for three months prior but denied using other substances and had no significant medical history. He was treated with anti-nausea medication and IV fluids and advised to cease marijuana use before being discharged.
Weeks later, his symptoms persisted, prompting another ER visit where he had lost an estimated 25 to 30 pounds. A urine test confirmed ongoing marijuana use. During this admission, doctors noted his confusion, slowed speech, and temporary unresponsiveness.
Despite interventions to correct dangerously low sodium levels, his cognitive impairment remained. By the fourth day of hospitalization, the teen exhibited rapid, involuntary eye movements, sensitivity to light, and difficulty walking. An MRI scan did not reveal the cause.
Identifying Wernicke Encephalopathy
Wernicke encephalopathy is typically characterized by a triad of symptoms: nystagmus (rapid eye movements), ataxia (loss of coordination), and altered mental state. However, this classic presentation appears in only a minority of patients, making diagnosis challenging. Many cases are only confirmed post-mortem.
The disorder arises from a severe lack of thiamine in the brain. While chronic alcohol abuse is the most common cause, malnutrition from other sources, such as eating disorders or cancer, can also lead to thiamine deficiency. If left untreated, WE can progress to Korsakoff syndrome, which can cause permanent memory and learning deficits in up to 85% of survivors. The overall mortality rate for Wernicke-Korsakoff syndrome is approximately 20%.
In this particular case, doctors suspected WE based on the teen's symptoms, even though an MRI had not definitively shown it. The test to confirm thiamine deficiency would take several days. Given that thiamine supplementation is considered low-risk, physicians administered IV thiamine every eight hours for two days, followed by oral thiamine pills for four days.
Recovery and Outcome
Within 24 hours of receiving thiamine, the teen showed significant improvement in his eye movements and cognitive function. He was subsequently discharged and agreed to abstain from cannabis use. CHS typically resolves once marijuana consumption ceases.
At his most recent follow-up appointment, the teen had regained his lost weight and his cognitive function had returned to normal. The case highlights how increased access to marijuana, particularly in various forms and higher potencies, may contribute to a rise in related health issues among adolescents, affecting their schooling, social interactions, and mental well-being.