Intern Report 2/23 – Wernickes

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.

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