Neuro

Wernicke's Encephalopathy

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Wernicke's Encephalopathy, Wernicke Encephalopathy, Wernickes Encephalopathy, Acute Thiamine Deficiency

  • History
  1. First described in 1881 by Dr. Carl Wernicke (polish neurologist) who recognized the classic triad
  • Cause
  1. Acute Thiamine Deficiency associated with Alcoholism
    1. Contrast with Chronic Thiamine deficiency (Beriberi)
  2. May also occur with malnourishment (similar causes of Beriberi)
    1. Hyperemesis Gravidarum
    2. Bariatric Surgery
    3. Chemotherapy
    4. Antiretroviral therapy
    5. Anorexia Nervosa
    6. Elderly with constrained diet
  • Signs
  1. Classic Triad (only present in one third of cases)
    1. Mnemonic: WACO (Wernicke's Ataxia Confusion Ophthalmoplegia)
    2. Ataxia
      1. Wide based unsteady gait
      2. Other coordination testing may be normal (e.g. normal Finger-Nose-Finger)
    3. Mental status changes or Altered Level of Consciousness
      1. Confusion or Delirium
      2. Apathy
      3. Inattention
      4. Drowsiness
      5. Decreased speech
      6. Shorty term memory deficit
    4. Ophthalmoplegia
      1. Horizontal Nystagmus is most common (but Vertical Nystagmus may also be present)
      2. Lateral Rectus Palsy (internal Strabismus, Conjugate Gaze Palsy, variably present)
  2. Other findings
    1. See Beriberi
    2. Hypothermia
    3. Hyperhidrosis
    4. Neuropsychiatric symptoms (psychomotor slowing, Seizures, depression, Dysphagia)
  • Differential Diagnosis
  • Complications
  1. Associated Mortality
  2. Korsakoff's Disease (Wernicke-Korsakoff Syndrome or Korsakoff's Psychosis)
    1. Life-long neurologic Impairment
    2. Associated with learning difficulties, memory difficulties, confabulation (invented memories)
  • Management
  1. Emergent Thiamine Dosing
    1. Start immediately without delay
    2. Glucose or dextrose given before Thiamine can precipitate encephalopathy
    3. Initial
      1. Thiamine 500 mg IV every 8 hours for 3 days (or more)
    4. Next
      1. Thiamine 50-100 mg orally, IV or IM daily
  2. Other management
    1. Magnesium
  • Resources
  1. Wernicke Encephalopathy (NIH Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK470344/
  • References
  1. Rendon et al. (2017) Crit Dec Emerg Med 31(6): 15-21