Wernicke's Encephalopathy

Key points

• Wernicke's encephalopathy 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,
• nystagmus (the most common ocular sign)
• ophthalmoplegia
• confusion, altered GCS
• peripheral sensory neuropathy
• TREATMENT — and the classic trap: give PARENTERAL THIAMINE (in the UK, Pabrinex or an equivalent vitamin B/C injection) BEFORE any glucose or carbohydrate load. Giving IV glucose first accelerates thiamine consumption and can precipitate or worsen Wernicke's encephalopathy.
• Treat on clinical suspicion — do not wait for confirmation, and do not require the full triad, which is present in only a minority.
• Untreated or inadequately treated Wernicke's progresses to KORSAKOFF'S SYNDROME: irreversible anterograde and retrograde amnesia with confabulation. Together these form the Wernicke–Korsakoff syndrome. Investigations