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Wernicke encephalopathy

Last reviewed: 23 Jun 2024
Last updated: 19 Aug 2020

Summary

Definition

History and exam

Key diagnostic factors

  • history of GI surgery
  • mental slowing, impaired concentration, and apathy
  • frank confusion
  • ocular motor findings
  • mental status changes, ophthalmoplegia, and gait dysfunction
Full details

Other diagnostic factors

  • alcohol dependence
  • pre-existing conditions that predispose to malnutrition: for example, AIDS, cancer, prolonged vomiting, or diarrhea
  • mild irritability
  • delirium
  • acute psychosis
  • coma
  • miosis, anisocoria, light/near dissociation
  • papilledema, retinal hemorrhages
  • tachycardia or hypotension
  • hypothermia or hyperthermia
  • hearing loss, seizures, and spastic paraparesis
  • ataxia
Full details

Risk factors

  • alcohol dependence
  • AIDS
  • cancer and treatment with chemotherapeutic agents
  • malnutrition
  • history of gastrointestinal surgery
  • genetics
  • bone marrow transplantation
  • infants who have been fed formula milk deficient in thiamine
  • male sex
Full details

Diagnostic tests

1st tests to order

  • therapeutic trial of parenteral thiamine
  • finger-stick glucose
  • CBC
  • serum electrolytes
  • renal function
  • LFTs
  • urinary and serum drug screen
  • serum ammonia
  • blood alcohol level
  • blood thiamine and its metabolites
  • serum magnesium
Full details

Tests to consider

  • lumbar puncture
  • MRI of brain
  • CT of brain
Full details

Treatment algorithm

ACUTE

moderate or high suspicion of Wernicke encephalopathy

low suspicion of Wernicke encephalopathy or mimics: at high risk for Wernicke encephalopathy

ONGOING

poor dietary intake and/or chronic alcoholism: at risk for Wernicke encephalopathy

Contributors

Authors

Abhay Moghekar, MB BS

Assistant Professor

Department of Neurology

Johns Hopkins Hospital

Baltimore

MD

Disclosures

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.

Peer reviewers

Adrian Priesol, MD, FRCPC

Instructor

Massachusetts Eye and Ear Infirmary

Harvard Medical School

Boston

MA

Disclosures

AP declares that he has no competing interests.

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