Wernicke encephalopathy is caused by a severe deficiency of thiamin Thiamin Deficiency Thiamin deficiency (causing beriberi and other problems) is most common among people whose diet mainly consists of white rice or highly processed carbohydrates in developing countries and among... read more , a B vitamin. In people who have only a small amount of thiamin stored in the body, it may be triggered by consuming carbohydrates.
Wernicke encephalopathy often develops in people with severe alcoholism Alcohol Alcohol (ethanol) is a depressant. Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma, and death. Genetics and personal characteristics may... read more because the long-term use of excess amounts of alcohol interferes with the absorption of thiamin from the digestive tract as well as the storage of thiamin in the liver. Also, people with alcohol use disorder often do not consume an adequate diet and thus not enough thiamin. Wernicke encephalopathy may result from other conditions that cause prolonged undernutrition or vitamin deficiencies. These conditions include dialysis, severe vomiting, starvation, gastric bypass surgery, cancer, and AIDS.
Symptoms of Wernicke Encephalopathy
Wernicke encephalopathy causes
Involuntary eye movements (nystagmus)
Partial paralysis of the eye muscles (ophthalmoplegia)
Loss of balance (To maintain balance, people walk with their feet far apart and take slow, short steps.)
Internal body processes may malfunction, causing tremor, agitation, a cold body temperature, a sudden and excessive decrease in blood pressure when people stand (orthostatic hypotension Dizziness or Light-Headedness When Standing Up In some people, particularly older people, blood pressure drops excessively when they sit or stand up (a condition called orthostatic or postural hypotension). Symptoms of faintness, light-headedness... read more ), and fainting.
Diagnosis of Wernicke Encephalopathy
A doctor's evaluation
Doctors suspect the diagnosis in people who have the characteristic symptoms and undernutrition or a thiamin deficiency, especially if they are people with alcohol use disorder.
Tests, such as blood tests to measure blood sugar levels, a complete blood cell count, liver tests, and imaging, are usually done to rule out other causes. Thiamin levels are not routinely measured.
Prognosis of Wernicke Encephalopathy
The prognosis depends on how quickly the disorder is diagnosed and treated. Prompt treatment may correct all abnormalities. Eye problems usually improve within 24 hours of treatment. However, loss of balance and confusion may persist days to months, and memory loss may not completely resolve.
Without treatment, about 10 to 20% of people die. 80% of survivors develop Korsakoff psychosis Korsakoff Psychosis Korsakoff psychosis is a complication of Wernicke encephalopathy and causes memory loss for recent events, confusion, and behavioral changes. (See also Drug Use and Abuse.) Korsakoff psychosis... read more , a disorder in which people develop memory loss, confusion, and behavioral changes. The combination is called Wernicke-Korsakoff syndrome.
Treatment of Wernicke Encephalopathy
Stopping drinking alcohol
Thiamin is given immediately by injection into a vein or muscle. It is continued daily for at least 3 to 5 days. Magnesium, which helps the body process thiamin, is also given by injection or by mouth. Fluids and multivitamins are given, and if levels of electrolytes (such as potassium Hypokalemia (Low Level of Potassium in the Blood) In hypokalemia, the level of potassium in blood is too low. A low potassium level has many causes but usually results from vomiting, diarrhea, adrenal gland disorders, or use of diuretics. A... read more ) are abnormal, they are corrected. Some people may require hospitalization.
People with Wernicke encephalopathy must stop drinking alcohol. Thiamin supplements, taken by mouth, may need to be continued after the initial treatment.