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Wernicke Encephalopathy

Definition

Wernicke encephalopathy is a brain disorder. It can lead to a variety of symptoms such as confusion, lack of muscle coordination, and eye movement difficulties.
Brain
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Causes

Wernicke encephalopathy is caused by thiamine (vitamin B1) deficiency. The deficiency may be caused by poor nutrition, problems absorbing vitamins, or both.
Vitamin B deficiency is common in those with alcoholism. Excessive intake of alcohol is associated with poor diets and damage to the intestines that make it difficult to absorb vitamins. However, not everyone with alcoholism develops Wernicke encephalopathy. A combination of genes and diet may play a role.

Risk Factors

Factors that may increase your risk of Wernicke encephalopathy include:
  • Alcoholism
  • Poor nutrition or fasting
  • A diet rich in carbohydrates
  • Cancer and chemotherapy treatments
  • Gastrointestinal disorders and surgical procedures
  • Severe vomiting
  • Systemic diseases such as AIDS, dialysis and renal diseases, infections, and thyroid disease
  • Eating disorders
  • Certain medications

Symptoms

Symptoms may include:
  • Mental status changes, including confusion, poor concentration, lack of emotion, and memory loss
  • Vision problems
  • Poor coordination
  • Difficulty walking and sitting
  • Nausea and vomiting

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis will be made if you have the typical findings.
Your blood will be tested for a thiamine level.

Treatment

Talk with your doctor about the best treatment plan for you. Options include:
  • Thiamin supplements—to treat the thiamine deficiency that is causing your Wernicke encephalopathy.
  • Dietary changes—you will need to drink plenty of water. You may also be referred to a dietitian to help with meal planning, especially if your diet is high in carbohydrates.
If Wernicke encephalopathy is associated with alcoholism or an eating disorder, you may be referred to a rehabilitation facility.

Prevention

To help reduce your chance of getting Wernicke encephalopathy, take these steps:
  • Ensure that you are getting enough thiamine in your diet.
    • Daily goals are 1.1 mg a day for women and 1.2 mg a day for men.
    • Include foods rich in thiamine such as lentils, peas, fortified breakfast cereal, pecans, spinach, oranges, milk, and eggs.
  • Limit your alcohol intake to a moderate level.
    • Moderate is two or fewer drinks per day for men and one or fewer drinks per day for women.
    • If you have a drinking problem, talk to your doctor right away about treatment options.

RESOURCES

Alzheimer’s Society http://www.alzheimers.org

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

Alzheimer Society Canada http://www.alzheimer.ca

Public Health Agency of Canada http://www.phac-aspc.gc.ca

References

Kaineg B, Hudgins M, et al. Wernicke’s encephalopathy. N Engl J Med. 2005;352:e18. Available at: http://www.nejm.org/doi/full/10.1056/NEJMicm040862. Accessed December 18, 2013.

Wernicke encephalopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 14, 2013. Accessed December 18, 2013.

Wernicke’s encephalopathy. University of Virginia School of Medicine website. Available at: http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles/ThomsonArticle.pdf. Accessed December 18, 2013.

Wernicke-Korsakoff syndrome. Patient UK website. Available at: http://www.patient.co.uk/doctor/Wernicke-Korsakoff-Syndrome.htm. Updated April 20, 2011. Accessed December 18, 2013.

Wernicke-Korsakoff syndrome. Radiopaedia website. Available at: http://radiopaedia.org/articles/wernicke-korsakoff-syndrome. Accessed December 18, 2013.

Wernicke-Korsakoff syndrome information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/wernicke%5Fkorsakoff/wernicke-korsakoff.htm. Updated February 14, 2007. Accessed December 18, 2013.

What is Korsakoff’s syndrome. Alzheimer’s Society website. Available at: http://www.alzheimers.org.uk/site/scripts/documents%5Finfo.php?documentID=98. Updated May 2012. Accessed December 18, 2013.

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