Condition- Wernicke's Encephalopathy Flashcards
What is Wernicke’s encephalopathy? A deficiency in what vitamin/ mineral causes it and which group of the population is more at risk?
A neuropsychiatric disorder caused by thiamine (B1) deficiency commonly seen in alcoholics
List three ways in which chronic alcoholism may lead to thiamine deficiency
- Inadequate nutritional thiamine intake + storage due to cirrhosis of liver where thiamine is stored
- Decreased thiamine absorption due to decreased gene expression for thiamine transporter-1
- Impaired thiamine utilisation by cells due to impaired conversion of thiamine to active form
Other than chronic alcoholics list some other risk factors for developing Wernicke’s encephalopathy
- Eating disorders
- Malnutrition
- Prolonged vomiting e.g. with chemotherapy
- GI malignancy
- Chronic subdural haematoma
- AIDS
- Hyperemesis gravidarum
- Thyrotoxicosis
List two areas of the brain which are commonly affected in Wernicke’s encephalopathy
- Mamillary bodies
- Cerebellum
What is the role of the mamillary bodies?
Memory
Emotion
Behaviour
List some of the presenting symptoms of Wernicke’s encephalopathy…
werNICke mnemonic
- Nystagmus/ opthalmoplegia
- Incoordination/ ataxia
- Confusion/ memory impairement- inability to form new memories
Other symptoms:
*
Korsokoff psychosis may also develop- what two additional symtpoms does this condition involve?
- Antero- and retrograe amnesia
- Confabulation
- werNICke’s symptoms
List some signs of Wernicke’s on clinical examination
- cachexia
- tachycardia, hypotension, hypothermia
- Nystagmus
- Abnormal, unsteady gait
- May show decreased reflexes and polyneuropathy
List some investigations you could carry out on someone with suspected Wernicke’s encephalopathy…
- Based on clinical examination and hx
- Could conduct bloods to exclude other causes:
- FBC (high MCV is a common feature amongst alcoholics)
- U&Es (exclude metabolic imbalances as a cause of confusion), LFTs, Glucose, ABG (hypercapnia and hypoxia can cause confusion)
- Serum thiamine
- Red cell transketolase activity is decreased – rarely done
- MRI head: degeneration of mamillary bodies
If an alcoholic patient presents to hospital with ataxia, nystagmus and confusion what is the most important step that should be taken?
- Administer thiamine infusion urgently to prevent progression of Wernicke’s encephalopathy to Wernicke’s-Korsokoff syndrome (Korsokoff psychosis) which has irreversibe implications
- Also give glucose afterwards