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Wernicke's Encephalopathy

Alternative Names
Korsakoff psychosis; Alcoholic encephalopathy; Encephalopathy - alcoholic; Wernicke's disease; Alcohol use - Wernicke; Alcoholism - Wernicke; Thiamine deficiency – Wernicke

What is Wernicke's encephalopathy?
Encephalopathy is a general term that means brain disease, damage, or malfunction.
Wernicke's encephalopathy (Also known as Wernicke's disease or Wernicke-Korsakoff syndrome) is a brain disorder due to vitamin B1 (thiamine) deficiency. These are actually two separate conditions that can occur at the same time. Usually, people get the symptoms of Wernicke’s encephalopathy first.
Wernicke's encephalopathy was originally described by German neurologist Karl Wernicke in 1881 as a classic triad of symptoms (mental confusion, ataxia and ophthalmoplegia).

What are the causes of Wernicke's encephalopathy?
Wernicke encephalopathy and Korsakoff syndrome are different conditions that often occur together. Both are due to brain damage caused by a lack of vitamin B1.
The number one cause of WKS is alcoholism.
The less common causes of WKS are conditions that limit nutritional absorption. Eating and nutrient absorption can be restricted by:
Gastric bypass surgery, which makes it difficult to meet nutritional needs due to limited food portions.
Colon cancer, which can cause pain that causes you to put off eating.
Eating disorders

Alcoholism is the number one cause of WKS because people who are alcoholics generally have a poor diet. Alcohol also prevents vitamin B-1 absorption and storage.

What are the signs and symptoms of Wernicke's encephalopathy?
Lesions on the brain cause Wernicke’s disease (WD). These lesions are the result of a vitamin B-1 deficiency.
Any patient with alcohol misuse who presents with confusion, nausea and vomiting, fatigue, weakness or apathy should be considered at high risk of Wernicke's encephalopathy and treated appropriately.

Prominent symptoms of Wernicke’s disease are:
Double vision
A drooping upper eyelid
Up-and-down or side-to-side eye movements
Loss of muscle coordination
A confused mental state

It can later develop into Korsakoff’s syndrome. People who have WKS have a variety of issues relating to memory. You may suffer from memory loss or be unable to form new memories.

Other symptoms may include:
Amnesia for events that happen after the onset of the disorder
Difficulty understanding the meaning of information
Difficulty putting words into context
Exaggerated storytelling, or confabulation

How is Wernicke's encephalopathy diagnosed?
Examination of the nervous/muscular system may show damage to many nerve systems and you doctor may notice:
Abnormal eye movement
Decreased or abnormal reflexes
Fast pulse (heart rate)
Low blood pressure
Low body temperature
Muscle weakness and atrophy (loss of tissue mass)
Problems with walk (gait) and coordination

Your doctor may also order nutritional tests to make sure you aren’t malnourished. Nutritional tests may include the following:
A serum albumin test measures the levels of albumin, which is a protein in the blood. Low levels of albumin may signal nutritional deficiencies as well as kidney or liver problems.
A serum vitamin B-1 test is a blood test to check vitamin B-1 levels in the blood. Enzyme activity in the red blood cells can be tested. Low enzyme activity in the red blood cells signals a vitamin B-1 deficiency.

You may also need imaging tests. These tests can help your doctor find any damage that’s characteristic of this disease.
Diagnostic imaging tests for WKS include:
Electrocardiogram (EKG) before and after giving vitamin B-1, which can help your doctor find abnormalities
CT scan to check for brain lesions
MRI scan to look for brain changes

What is the treatment of Wernicke's encephalopathy?
A multidisciplinary service tailored to the needs of individual patients, including the management of alcohol abuse.
Treatment of encephalopathy varies with the primary cause of the symptoms. Consequently, not all cases of encephalopathy are treated the same.
Treatment may first involve hospitalization. At the hospital, you’ll be monitored to ensure your digestive system is absorbing food properly.

The treatment  may include:
Vitamin B-1 given through an IV in the arm or hand
Vitamin B-1 given by mouth
A balanced diet to keep vitamin B-1 levels up
Treatment for alcoholism

In a small number of cases, treatment of vitamin B-1 deficiency produces a negative reaction. This is more common in alcoholics.
Negative reactions to receiving vitamin B-1 may vary. Reactions may include alcohol withdrawal symptoms like insomnia, sweating, or mood swings. You may also experience hallucinations, confusion, or agitation.

What are the complication of Wernicke's encephalopathy?
Complications of encephalopathy vary from none to profound mental impairments that lead to death. The complications can be similar in some cases. Also, many investigators consider encephalopathy itself to be a complication that arises from a primary health problem or primary diagnosis.

Complications that may result include:
Alcohol withdrawal
Difficulty with personal or social interaction
Injury caused by falls
Permanent alcoholic neuropathy
Permanent loss of thinking skills
Permanent loss of memory
Shortened life span

What is the prognosis Wernicke's encephalopathy?
Wernicke's encephalopathy is a medical emergency. The outlook for WKS is based on how far the disease has advanced. If left untreated, it leads to death in up to 20% of cases, or to the Korsakoff's syndrome in 85% of survivors. Up to 25% of the Korsakoff group will require long-term institutionalisation.

Those who receive fast treatment can see progress in:
Eye problems
Muscle coordination
You must abstain from alcohol to continue recovery of memory and mental function.

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