Wernicke's encephalopathy

Question 1

What is Wernicke’s encephalopathy?

Answer 1

Wernicke’s encephalopathy is a neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics.

Question 2

Rarer causes include ?

Answer 2

persistent vomiting, stomach cancer, and dietary deficiency. A classic triad of ophthalmoplegia/nystagmus, ataxia and encephalopathy may occur.

Question 3

What occurs physiologically in Wernicke’s encaephalopathy?

Answer 3

petechial haemorrhages occur in a variety of structures in the brain including the mamillary bodies and ventricle walls.

Question 4

Clinical features of Wernicke’s encephalopathy?

Answer 4

oculomotor dysfunction
- nystagmus (the most common ocular sign)
- ophthalmoplegia: lateral rectus palsy, conjugate gaze palsy

gait ataxia
encephalopathy: confusion, disorientation, indifference, and inattentiveness

peripheral sensory neuropathy

Question 5

Investigations for Wernicke’s encephalopathy?

Answer 5

decreased red cell transketolase
MRI

Question 6

Treatment of Wernicke’s encephalopathy ?

Answer 6

urgent replacement of thiamine

Question 7

Relationship with which syndrome if Wernicke’s not treated?

Answer 7

If not treated Korsakoff’s syndrome may develop as well. This is termed Wernicke-Korsakoff syndrome and is characterised by the addition of antero- and retrograde amnesia and confabulation in addition to the above symptoms.