Wernicke encephalopathy

Definition

• Syndrome of cerebellar ataxia, ophthalmoplegia (usually bilateral CN VI palsies), and global confusion caused by vitamin B1 deficiency
  • Often has horizontal nystagmus
• When there is additional amnesia, with or without confabulation, the syndrome is known as Wernicke-Korsakoff syndrome

Etiology

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

Differential Diagnosis

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

Clinical Presentation

• Only a third present with the classic triad
• 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

Management

• Thamine 200-500mg IV/IM TID x3 days

Prognosis

• Often leads to Korsakoff syndrome