Wernicke's Encephalopathy: Increasing Clinician Awareness of This Serious, Enigmatic, Yet Treatable Disease - PubMed (original) (raw)

. 2015 May 21;17(3):10.4088/PCC.14r01738.

doi: 10.4088/PCC.14r01738. eCollection 2015.

Affiliations

Wernicke's Encephalopathy: Increasing Clinician Awareness of This Serious, Enigmatic, Yet Treatable Disease

Alexandra Flynn et al. Prim Care Companion CNS Disord. 2015.

Abstract

Objective: Undiagnosed and/or undertreated Wernicke's encephalopathy can result in permanent brain damage, long-term institutionalization, and death. The purpose of this article is to heighten clinical awareness of Wernicke's encephalopathy and shed light on its diagnosis and treatment, which are often inconsistent due to unclear diagnostic criteria and limited practice guidelines. An update on the management of Wernicke's encephalopathy is presented and several case reports and a quality improvement project from our hospital are described.

Data sources: PubMed, the Cochrane Database of Systematic Reviews, and PsycINFO were searched for English-language articles published between January 1991 and January 2014 using combinations of the following keywords: Wernicke's encephalopathy, diagnosis, treatment/guideline(s), and thiamine.

Study selection: The automated search identified over 500 articles. A manual review of the related citations and reference lists from articles of interest was also conducted. The articles reviewed were chosen on the basis of author consensus and because they represented expert opinion or the highest quality of evidence available.

Results: Diagnostic criteria are reviewed in this article and should be used to diagnose Wernicke's encephalopathy with high sensitivity and specificity. The European Federation of Neurologic Societies and the Royal College of Physicians issued national guidelines for the diagnosis, prevention, and treatment of Wernicke's encephalopathy. No benchmark national guidelines for treating Wernicke's encephalopathy exist in the United States.

Conclusions: Whenever Wernicke's encephalopathy is suspected, treatment should be initiated immediately with intravenous thiamine because oral thiamine is inadequate for preventing permanent brain damage. An adequate dose of intravenous thiamine administrated in a timely manner is a safe and life-saving treatment for Wernicke's encephalopathy that could preserve brain cells and function.

PubMed Disclaimer

Figures

Figure 1.

Figure 1.

Quality Improvement Project “Wernicke’s Encephalopathy: Adequate Treatment of Thiamine Deficiency in Alcohol Users”

References

    1. Thomson AD. Mechanisms of vitamin deficiency in chronic alcohol misusers and the development of the Wernicke-Korsakoff syndrome. Alcohol Alcohol suppl. 2000;35(1):2–7. - PubMed
    1. Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry. 1986;49(4):341–345. - PMC - PubMed
    1. Victor M, Adams R, Collins G. Philadelphia, PA: F.A. Davis; 1989. The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and Malnutrition.
    1. Donnino MW, Vega J, Miller J, et al. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know. Ann Emerg Med. 2007;50(6):715–721. - PubMed
    1. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442–455. - PubMed

LinkOut - more resources