The diagnosis of Wernicke's encephalopathy is often missed. In postmortem series, only 1% to 20% of patients were diagnosed antemortem. The classic clinical triad of mental status changes, ophthalmoplegia, and gait dysfunction is present in only 10% of cases. The clinical manifestations are varied, and patients without any of the classic findings have been described, accounting for the low level of diagnostic accuracy of this condition. Hence a high index of suspicion is necessary in assessing persons at risk for thiamine deficiency. Laboratory tests to confirm thiamine deficiency and imaging findings suggestive of it may not be available in a timely manner and may not be sufficiently sensitive or specific. Wernicke's encephalopathy remains a clinical diagnosis, warranting prompt treatment. A delay in diagnosis may have long-term consequences.
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