Teaching Points:

• Wernicke’s Syndrome presents as a clinical triad of:
  • Encephalopathy
  • Ataxia
  • Ophthalmoplegia
• The presence of all three characteristics is not needed in order to make the clinical diagnosis.
  • An under-recognized disease
• Due to the lack of vitamin B1 (thiamine).
• Most common presentation is encephalopathy.
  • Can manifest as indifference, confusion, poor attention span.
  • Can rarely present as agitation in the setting of alcohol withdrawal.
  • Severe cases can progress to stupor and coma
• Second most common sign is ataxia
  • Ataxia can present itself before encephalopathy
• Ophthalmoplegia
  • Presence of lateral right and left nystagmus, lack of smooth pursuit
  • Severe cases can cause pupillary defects
• Patients do not have to be alcoholics in order to get Wernicke’s disease.
  • Can be seen in those with poor oral intake, malnutrition, high catabolic states (sepsis), and those with poor utilization of thiamine (poor overall body substrate).
• Initiation of glucose prior to thiamine administration may actually precipitate Wernicke’s syndrome.
• Treatment involves high dose thiamine administration, with 500mg IV q8 hours x 2 days, then daily for 5-7 days.
• Response can be seen within hours to days.
• Untreated and prolonged Wernicke’s may lead to Korsakoff psychosis.
  • Presents with anterograde and retrograde amnesia (long term memory retained), and confabulation.
  • A more irreversible disease course.