Wernicke's encephalopathy

Question 1

What is it?

Answer 1

Wernicke’s encephalopathy is a neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics. Rarer causes include persistent vomiting, stomach cancer, and dietary deficiency. A classic triad of ophthalmoplegia/nystagmus, ataxia and encephalopathy may occur.

In Wernicke’s encephalopathy, petechial haemorrhages occur in a variety of structures in the brain including the mamillary bodies and ventricle walls.

Question 2

Features?

Answer 2

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 3

Investigations

Answer 3

decreased red cell transketolase
MRI

Question 4

Treatment

Answer 4

urgent replacement of thiamine

Question 5

Wernicke-Korsakoff?

Answer 5

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.