July 20, 2020 e-Pearl of the Week: Wernicke’s Encephalopathy

Wernicke’s Encephalopathy

Wernicke’s encephalopathy presents as acute/subacute altered mental status, truncal ataxia, ophthalmoplegia (bilateral Abducens palsy), and gaze-evoked nystagmus.1 Risk factors are chronic malnutrition, alcohol abuse, hyperemesis gravidarum, malignancies, AIDS, and are precipitated by infections or carbohydrate load.2 Thiamine deficiency decreases metabolic substrates, generating excess lactate and resulting in neuronal cell damage.1 Confirmatory laboratory tests should not delay treatment. MRI shows T2-FLAIR signal in mammillary bodies, dorsomedial thalamus, periaqueductal mesencephalon and superior cerebellar vermis.1,2,4 Parenteral thiamine 500mg TID often improves clinical symptoms;3 co-administration of glucose prevents acute crisis.3 Complications include Korsakoff Syndrome (disorientation, confabulations and anterograde amnesia)4 and acute cardiovascular collapse (Shoshin beriberi).1

References

  1. Aminoff, M. (2008). Neurology and general medicine. Philadelphia: Churchill Livingstone, pp.280–281.
  2. Flynn A, Macaluso M, D’Empaire I, Troutman MM. Wernicke's Encephalopathy: Increasing Clinician Awareness of This Serious, Enigmatic, Yet Treatable Disease. Prim Car Companion CNS Disord 2015;17:10.4088/PCC.14r01738.
  3. Vasan S, Kumar A. Wernicke Encephalopathy. [Updated 2019 Nov 16]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Jan.
  4. Covell T, Siddiqui W. Korsakoff Syndrome. [Updated 2019 May 5]. In: StatPearls. Treasure Island (FL): StatPearls Publishing;2020.

Submitted by Neha Sharma, MD, Windsor University SOM, and Faisal Khan MD, DABSM, DABPN, Consultant Neurologist, Sugarland Neurology and Sleep (Sugar Land, Texas)

Neha Sharma and Dr. Khan report no disclosures.