Wernicke’s Encephalitis (WE) Triad:
3) Oculomotor dysfunction
* presence of all 3 symptoms is not needed in order to make the clinical diagnosis; only approximately 10% of patients will display all 3 symptoms.
Korsakoff Syndrome (additional 2 findings):
4) Selective anterograde/retrograde amnesia
WE is an under-recognized disease with a prevalence of 0.4 – 2.8% in the general population and up to 12.5% in alcohol abusers.
WE is more common in men, but women are more susceptible to development.
Caine Criteria – proposed in 1997 (article below) – only need 2 of 4 for diagnosis
1) Dietary deficiency
2) Oculomotor dysfunction
3) Cerebellar dysfunction
4) AMS or mild memory impairment
* study of 106 autopsied alcoholics found that use of the Caine criteria from the standard WE triad increased the diagnostic sensitivity from 22% (classic triad) to 85% (Caine criteria).
Remember that WE can be associated with a number of conditions/diseases (not a compelte list):
– Chronic alcoholism
– GI surgery (esp. bariatric)
– Prolonged IV feeds without supplementation
– Sepsis (high catabolic state)
Pathophysiology – WE is due to thiamine (vitamin B1) deficiency. Remember to WE is a clinical diagnosis and treatment should be started early to prevent irreversible damage. Response to therapy may be diagnostic.
No lab testing is needed for diagnosis!
Thiamine IV 500 mg TID Days 1-2
Thiamine IV 250 mg BID Days 3-5
Thiamine PO 100 mg daily, which should be continued until the patient is no longer at risk.
* Avoid glucose before thiamine if possible – can precipitate an episode of WE.