Wernicke's encephalopathy Flashcards
What is Wernicke’s encephalopathy?
Neuropsychiatric disorder causes by thiamine deficiency
Who does Wernicke’s encephalopathy most commonly effect?
pts with a history of chronic alcohol abuse
What are some rarer causes of Wernicke’s encephalopathy? (not alcohol)
Peristent vomiting e.g. hyperemesis gravidarum
stomach cancer
malnutrition e.g prolonged paraenteral nutrition w/o supplements
bariatric surgery
What is the classic triad of clinical features found in Wernicke’s encephalopathy?
Ataxia
Confusion
Opthalmoplegia / nystagmus»_space;»> e.g. gaze-evoked nystagmus, spontaneous upbeat nystagmus, and horizontal or vertical ophthalmoplegia
Where do petechial haemorrhages occur in Wernicke’s encephalopathy?
Many places in brain e.g. mamillary bodies and ventricle walls
List common clinical features found in patients with Wernicke’s encephalopathy
nystagmus (most common ocular sign)
ophthalmoplegia
ataxia
confusion, altered GCS
peripheral sensory neuropathy
What investigations would you do for Wernicke’s encephalopathy?
decreased erythrocyte transketolase (ETK) levels (enzyme assay as this enzyme relies on thiamine)
MRI
- T2/FLAIR - increased signal intensity often in mammillary bodies, thalamus etc.
What is the treatment for Wernicke’s encephalopathy?
High dose IV thiamine (B1): Pabrinex IV
What is the relationship between Wernicke’s encephalopathy an Korsakoff syndrome?
Wernicke’s if untreated can progress to Wernicke-Korsakoff syndrome
Korsakoff’s- irreversible amnesic condition. due to damage to areas of the brain including the hypothalamus and mammillary bodies.
results in anterograde and retrograde amnesia, and confabulation, where the patient invents memories but they actually believe these are true. Patients lack insight into their condition.
What are the features of Wernicke-Korsakoff syndrome?
antero- and retrograde amnesia
confabulation
Plus: Wernicke’s symptoms.
NOTE: Anterograde amnesia (AA) - impaired capacity for new learning. Retrograde amnesia (RA) - loss of information that was acquired before the onset of amnesia.
Confabulation - the production of false / erroneous memories without the intent to deceive.
Who do alcoholics tend to have Thiamine (B1) deficiency?
Thiamine is poorly absorbed in presence of alcohol
poor diet relying on booze for calories
Is Wernicke’s encephalopathy reversible ?
yes with emergency treatment but high mortality
Korsakoff is often irreversible and need full time institutional care
