Wernicke's syndrome (Wernicke's encephalopathy)
Jump to navigation
Jump to search
Introduction
A condition frequently observed in alcoholics often coexistent with Korsakoff's syndrome.
Etiology
- thiamine deficiency
- alcoholism
- vitamin-free fluid intake (parenteral nutrition)
- hyperemesis gravidarum
- bariatric surgery[2]
- prolonged fasting
- malnutrition &/or malabsorption syndromes
- infection is the most common precipitating event in patients with thiamine deficiency
- superior hemorrhagic polio-encephalitis
Pathology
- carbohydrate metabolism exhausts thiamine stores in:
- thalamus (dorsal, medial)
- brainstem
- mammillary bodies
- transketolase insufficiency results from thiamine deficiency
- gliosis in mammillary bodies & periaqueductal gray
Clinical manifestations
- classic triad
- ophthalmoplegia
- ataxia
- confusion (encephalopathy)
- global
- listlessness
- inattentiveness/lack of concentration
- amnesia, dementia
- confabulation
- autonomic insufficiency
- hypertension (rare
- tremors
- anxious insomnia, fear of dark
Radiology
- MRI neuroimaging with fluid attenutated inversion recovery
- hyperintensity of the mammillary bodies & periaqueductal gray matter
Complications
- progression to Korsakoff's syndrome
Differential diagnosis
- synthetic cannabinoid toxicity
Management
- thiamine
- 100 mg IV/IM PRIOR to carbohydrate loading
- then 100 mg PO QD
- treat until opthalmoplegia resolves
- rehydration
- correct electrolyte imbalances
- multivitamins including folate
- prognosis:
- may clear in days to weeks
- may progress to Korsakoff's syndrome
More general terms
More specific terms
Additional terms
- Korsakoff's syndrome (amnesic psychosis)
- thiamine (vitamin B1, Betalin)
- Wernicke's aphasia; fluent aphasia; garbled speech
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15, 16. American College of Physicians, Philadelphia 2009, 2012
- ↑ 2.0 2.1 Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008 Nov;248(5):714-20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18948797
- ↑ Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Donnino MW, Vega J, Miller J, Walsh M. Myths and misconceptions of Wernicke's encephalopathy: what every emergency physician should know. Ann Emerg Med. 2007 Dec;50(6):715-21. Epub 2007 Aug 3. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17681641
- ↑ Galvin R, Brathen G, Ivashynka A et al EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010 Dec;17(12):1408-18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20642790
- ↑ NEJM Knowledge+ Psychiatry
Kaineg B, Hudgins PA. Images in clinical medicine. Wernicke's encephalopathy. N Engl J Med. 2005 May 12;352(19):e18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15888690 Free article. https://www.nejm.org/doi/pdf/10.1056/NEJMicm040862
Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007 May;6(5):442-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17434099 Review.
Patient information
Wernicke's syndrome patient information