Wernicke's encephalopathy Flashcards
What is Wernicke’s encephalopathy?
Neuropsychiatric disorder caused by thiamine deficiency
Most commonly seen in alcoholics. Rarer causes inc. persistent vomiting, stomach cancer, + dietary deficiency.
What is the classic triad seen in Wernicke’s encephalopathy?
Oculomotor dysfunction: nystagmus, diplopia, conjugate gaze palsy
Ataxia
Confusion
Describe ophthalmoplegia in WE
Unilateral or bilateral dysfunction of eye movement
Often affecting lateral rectus + medial rectus muscles.
What is conjugate gaze palsy?
An impaired ability of the eyes to move in a single direction (e.g., horizontal or vertical)
Describe nystagmus in WE
Most common ocular sign
Horizontal, vertical, or rotary Nystagmus
Often exacerbated by lateral gaze
Describe ataxia in WE
Widebased unsteady gait + difficulties in maintaining an upright posture.
Describe the symptoms of encephalopathy in WE
Confusion (early): disoriented, unable to concentrate, or have difficulty following conversations.
What is diagnosis of Wernicke’s encephalopathy mainly based on?
Clinical dx
What investigations may be useful in Wernicke’s encephalopathy ?
FBC: high MCV common in alcoholics
U+Es: r/o metabolic imbalances
LFTs: high
Glucose: r/o high or low as causes of confusion
ABG: hypercapnia + hypoxia can cause confusion
Serum thiamine
Describe management of Wernicke’s encephalopathy
Urgent IV Thiamine min. 5 days
Continue Thiamine PO
Why must care be taken when administering glucose in those with suspected WE?
Glucose metabolism requires thiamine + such metabolism will further reduce thiamine levels. Thiamine must be administered before or concurrently with any glucose administration.
What does deterioration of Wernicke’s encephalopathy result in?
Wernicke-Korsakoff’s Syndrome
What are the features of Wernicke-Korsakoff’s syndrome?
Amnesia (antero + retrograde)
Confabulation
Personality changes
