Resumen
Definición
History and exam
Key diagnostic factors
- história de cirurgia gastrointestinal
- lentidão mental, confusão, deficiência de concentração e apatia
- sinais oculomotores
- história de transtornos decorrentes do uso de bebidas alcoólicas
- condições preexistentes que predispõem à desnutrição: por exemplo, HIV/AIDS, câncer, anorexia/bulimia, vômitos prolongados ou diarreia
- tríade clássica: alterações no estado mental, oftalmoplegia e disfunção da marcha
Other diagnostic factors
- irritabilidade leve
- psicose aguda
- coma
- miose, anisocoria, dissociação luz-perto
- papiledema, hemorragias retinianas
- taquicardia ou hipotensão
- hipotermia ou hipertermia
- perda auditiva, crises epilépticas e paraparesia espástica
- ataxia
Risk factors
- transtornos decorrentes do uso de bebidas alcoólicas
- Infecção por HIV e AIDS
- câncer e tratamento com agentes quimioterápicos
- desnutrição
- história de cirurgia gastrointestinal
- variantes genéticas associadas ao metabolismo e transporte alterados da tiamina
- transplante de medula óssea
- sexo masculino
Diagnostic investigations
1st investigations to order
- tentativa terapêutica de tiamina parenteral
- tiamina sérica
- ressonância nuclear magnética (RNM) cranioencefálica
- glicose sanguínea
- Hemograma completo
- eletrólitos séricos
- função renal
- TFHs
- análise toxicológica
- amônia sérica
- nível de álcool no sangue
Investigations to consider
- punção lombar
Treatment algorithm
suspeita de encefalopatia de Wernicke
alto risco de deficiência de tiamina
Contributors
Authors
Gregory S. Day, MD, MSc, MSCI, FAAN, FANA, FANA
Associate Professor of Neurology
Division Director, Behavioural Neurology
Mayo Clinic in Florida
Jacksonville
FL
Disclosures
GSD declares no competing interests directly relevant to this work. His research is supported by the National Institute of Health (U01AG057195, U01NS120901, U19AG032438). He serves as a consultant for Parabon NanoLabs, Inc. and as a topic editor (Dementia) for DynaMed (EBSCO). He is the co-project principal investigator for a clinical trial in anti-NMDAR encephalitis, which receives support from the National Institute of Neurological Disorders and Stroke (U01NS120901) and Amgen Pharmaceuticals, and a consultant for Arialys Therapeutics. He has developed and edited educational materials for Continuing Education, Inc. and Ionis Pharmaceuticals. GDS owns stock in ANI Pharmaceuticals. His institution has received support from Eli Lilly and Company for development and participation in an educational event promoting early diagnosis of symptomatic Alzheimer's disease, and in-kind contributions of radiotracer precursors for tau-PET neuroimaging in studies of memory and aging (via Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly and Company).
Acknowledgements
Dr Gregory S. Day would like to gratefully acknowledge Dr Abhay Moghekar, a previous contributor to this topic. 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Galvin R, Bråthen G, Ivashynka A, et al. Guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010 Dec;17(12):1408-18.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Intoxicação alcoólica
- Abstinência alcoólica
- Encefalite viral
More DifferentialsGuidelines
- Alcohol-use disorders: diagnosis and management of physical complications
- Guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy
More Guidelines
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