Caused by the acute deficiency of thiamine in a susceptible host.
Underdiagnosed in clinical practice.
The spectrum of patients affected continues to increase with changing medical practice.
The neuropsychiatric manifestations are varied but typically include alterations of consciousness, eye movement abnormalities, and gait and balance disorders.
Unless treated as an emergency with thiamine replacement parenterally, permanent neurologic injury may occur.
Wernicke encephalopathy is a neurologic emergency resulting from thiamine deficiency with varied neurocognitive manifestations, typically involving mental status changes and gait and oculomotor dysfunction.
History and exam
- alcohol dependence
- pre-existing conditions that predispose to malnutrition: for example, AIDS, cancer, prolonged vomiting, or diarrhea
- mild irritability
- acute psychosis
- miosis, anisocoria, light/near dissociation
- papilledema, retinal hemorrhages
- tachycardia or hypotension
- hypothermia or hyperthermia
- hearing loss, seizures, and spastic paraparesis
Abhay Moghekar, MB BS
Department of Neurology
Johns Hopkins Hospital
AM is a medical advisory board member of the Hydrocephalus Association and was reimbursed for travel and airfare. AM was a consultant to Quest Diagnostics and Orbees Incorporation for market research, receiving payment for consulting. AM undertook research for Fujirebio Diagnostics and received a research grant to his lab at Johns Hopkins University.
Adrian Priesol, MD, FRCPC
Massachusetts Eye and Ear Infirmary
Harvard Medical School
AP declares that he has no competing interests.
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