Wernicke's Encephalopathy

Question 1

What is the definition of Wernicke’s encephalopathy?

Answer 1

Neurological disorder caused by thiamine (vitamin B1) deficiency, manifesting in a triad of specific clinical symptoms: ataxia, confusion, ocular abnormalities.

Question 2

What are the causes of Wernicke’s encephalopathy?

Answer 2

Chronic alcohol abuse
Malnutrition
Bariatric surgery
Hyperemesis gravidarum

Question 3

What are the clinical features of Wernicke’s encephalopathy?

Answer 3

Ataxia: unsteady and uncoordinated movements
Confusion: disorientation and difficulty with attention
Ocular abnormalities: gaze-focused nystagmus, spontaneous upbeat nystagmus, horizontal or vertical ophthalmoplegia

Only 10% of patients present with all three

Question 4

What are some investigations for Wernicke’s encephalopathy?

Answer 4

Neurological exam
Bloods (low thiamine levels and other signs of malnutrition/alcohol abuse)
MRI head (characteristic changes in mammillary bodies and periaqueductal gray area)

Question 5

What is the management of Wernicke’s encephalopathy?

Answer 5

Replacement of thiamine (high dose IV Pabrinex)
Treat underlying cause (eg counselling and support)

Question 6

What is a complication of Wernicke’s encephalopathy?

Answer 6

Korsakoff’s syndrome
(Disorder affecting the mammillary bodies presenting with profound anterograde amnesia, limited retrograde amnesia, and confabulation)

Question 7

What is the management of Korsakoff’s syndrome?

Answer 7

Ongoing thiamine supplementation
Cognitive rehabilitation
Careful management of patient’s environment