Wernicke's Enceophalopathy Flashcards
What are causes of WE?
acute deficiency of thiamine in a susceptible host
What are RF for WE?
- History of GI surgery
- AIDS
- Cancer
- Prolonged vomiting or diarrhoea
- Alcoholic misuse
What can WE be due to?
- Decreased intake (oral or parenteral)
- Relative deficiency due to increased demand
- Malabsorption from GI tract
What are symptoms and signs of WE?
- Alterations in consciousness
- Eye movement abnormalities
- Gait and balance disorders
- Frank confusion
- Mental slowing, impaired concertation and apathy
What is the WE triad?
- Confusion
- Ataxia
- Ophthalmoplegia
What are DDx for WE?
- Alcohol intoxication
- Alcohol withdrawal
- Viral encephalitis
- Miller-Fisher syndrome
- Primary CNS lymphoma
What are the tests for WE?
therapeutic trial of parenteral thiamine
What bloods are done for WE?
- Finger prick glucose
- FBC
- Serum electrolytes
- Renal function
- LFTs
- Urinary and serum drug screen
- Serum ammonia
- Blood alcohol level
- Blood thiamine and its metabolites
- Serum magnesium
What do the blood tests in WE usually show?
all normal or low unless e.g. chronic alcohol use so makes WE more likely so shows up in LFTs
How is diagnosis made for WE?
clinical diagnosis and red cell transketolase activity decreased (rarely done)
What is the acute treatment of moderate/high suspicion of Wernicke’s: 1st line?
- Stabilisation/resuscitation
- Thiamine: 150-500mg IV every 8 hours
- Magnesium: mg sulphate 2-4g/day IV
- Multivitamins
What is the acute treatment of low sus suspicion of Wernicke’s: 1st line?
- Thiamine
- Magnesium
- Folic acid
What is the chronic treatment of WE?
thiamine dietary supplement: thiamine 100-200mg orally once daily
Do you give glucose or thiamine first?
give thiamine before glucose if hyperglycaemia
What are possible complications of WE?
- Ataxia and varying degrees of ophthalmoparesis
- Korsakoff’s psychosis
- Hearing loss
- Seizures
- Spastic paraparesis
