From the Guidelines
Wernicke's encephalopathy is a severe neurological condition caused by thiamine (vitamin B1) deficiency, which can be fatal if left untreated, and prompt administration of thiamine is essential to prevent progression to Korsakoff syndrome and other complications. This condition is most commonly seen in people with alcohol use disorder, but it can also occur in individuals with severe malnutrition, prolonged vomiting, or after bariatric surgery 1. The classic triad of symptoms includes confusion, abnormal eye movements (nystagmus and ophthalmoplegia), and difficulty with coordination and walking (ataxia) 1.
Key Considerations
- Thiamine deficiency can present with a range of clinical signs and symptoms involving the neurological, psychiatric, and cardiovascular systems 1
- Early suspicion and recognition of thiamine deficiency are crucial to enable immediate initiation of therapy, as thiamine reserves are depleted as early as 20 days of inadequate oral intake 1
- When treating suspected Wernicke's encephalopathy, thiamine should always be given before any glucose administration, as glucose can actually worsen the condition by depleting remaining thiamine stores 1
Treatment and Prevention
- Immediate treatment involves administering thiamine, typically 500mg intravenously three times daily for 2-3 days, followed by 250mg daily until symptoms improve, then oral thiamine supplementation 1
- In people at risk of thiamine deficiency or with clinical suspicion of acute deficiency, additional thiamine and vitamin B compound strong should be given immediately, i.e., oral thiamine 200–300 mg d−1 and vitamin B compound strong 1 or 2 tablets three times a day, or full dose daily intravenous vitamin B preparation, if necessary for those unable to tolerate thiamine orally 1
- Oral or intravenous glucose must not be given to people at risk of or with suspected thiamine deficiency as it can precipitate Wernicke–Korsakoff syndrome 1
From the Research
Definition and Causes of Wernicke's Encephalopathy
- Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality 2.
- The disorder can be caused by various factors, including inadequate diet, insufficient gastrointestinal absorption, and enzymatic abnormalities, and is most commonly seen among patients with alcohol abuse 3.
- It can also be associated with other conditions, such as gastrointestinal disorders, malnutrition, and folate deficiency 4.
Clinical Settings and Symptoms
- Wernicke's encephalopathy can occur in various clinical settings, including patients with cerebral infarction, cancer, AIDS, and gastric phytobezoar 5, 4.
- The symptoms of Wernicke's encephalopathy can vary, but common symptoms include confusion, ataxia, ophthalmoplegia, cognitive dysfunction, and gait instability 2, 5, 3.
- The diagnosis of Wernicke's encephalopathy can be challenging, as the classical triad of signs occurs in only 10% of cases, and the presentation is often non-specific 6.
Diagnosis and Treatment
- Early recognition and differential diagnosis of Wernicke's encephalopathy are crucial, as prompt treatment with high-dose parenteral thiamine can improve the outcome 2, 6.
- The treatment of Wernicke's encephalopathy consists of large doses of intravenous thiamine, which is effective and safe 3.
- Preventive treatment with parenteral thiamine should be offered to patients with an alcohol problem associated with malnutrition, as well as to patients at risk of thiamine deficiency due to gastrointestinal disorders or other conditions 4, 6.