Wernicke encephalopathy

Background

• Syndrome of cerebellar ataxia, ophthalmoplegia (usually bilateral CN VI palsies), and global confusion caused by vitamin B1 deficiency, usually in the context of chronic alcohol use, and often in the context of a combined Wernicke-Korsakoff syndrome

Pathophysiology

• Thiamine (vitamin B1) deficiency, often associated with chronic alcohol abuse

Clinical Manifestations

• Only a third present with the classic triad of cerebellar ataxia, ophthalmoplegia (usually bilateral CN VI palsies), and global confusion
• Most are disoriented and inattentive
• Ophthalmoplegia
  • Horizontal nystagmus
  • Lateral rectus (CN VI) palsy (usually bilateral)
  • Conjugate gaze palsies
  • Ptosis
• Gait ataxia
• Spares pupils unless severe
• When there is additional amnesia, with or without confabulation, the syndrome is known as Wernicke-Korsakoff syndrome

Differential Diagnosis

• Alcohol use disorder is most common
• Other causes of malnutrition, including hyperemesis, starvation, dialysis, cancer, HIV/AIDS, or rarely gastric surgery

Management

• Thamine 200 to 500mg IV/IM TID x3 days

Prognosis

• Often leads to Korsakoff syndrome