Wernicke encephalopathy

Question 1

What is Wernicke’s encephalopathy?

Answer 1

Neurological symptoms as a result of biochemical lesions because of vitamins B1 deficiency

Question 2

What is the triad of symptoms of Wernicke’s encephalopathy?

Answer 2

Ocular disturbances, ataxia, and confusion

Small percentage all three, most likely in alcohol abuse

Question 3

What can cause Wernicke’s encephalopathy?

Answer 3

Pancreatitis, liver dysfunction, coeliac disease

Vomiting

Starvation, fasting

Chemotherapy

Cancer, AIDS

Chronic inflammation, diabetes

Question 4

What is the pathogenesis of Wernicke’s encephalopathy?

Answer 4

Three-fold injury:

1. Oxidative damage
2. Mitochondrial injury
3. Stimulation of pro-apoptotic pathway

These pathways cause lesions in different parts of the brain

Question 5

How would you diagnose Wernicke’s encephalopathy?

Answer 5

Two or more of the classic symptoms (within or outside of the triad)

Question 6

What are the classic symptoms of Wernicke’s encephalopathy?

Outside the triad

Answer 6

Jerky eye movements, pupillary changes, vision loss, impaired vision

Hearing loss

Memory impairment, confusion, coordination, amnesia, hypothermia

Question 7

How do you treat Wernicke’s encephalopathy?

Answer 7

Most symptoms will improve quickly if deficiencies are treated early. Memory disorder may be permanent

500 mg of thiamine hydrochloride, delivered by infusion over a 30-minute period for two to three days
Treat underlying cause

Question 8

What sort of beriberi is Wernicke’s encephalopathy?

Answer 8

Dry

Question 9

What is Beriberi?

Answer 9

Severe longterm thiamine deficiency

Question 10

What system does wet beriberi affect?

Answer 10

Cardiovascular

Question 11

What system does dry beriberi affect?

Answer 11

Nervous system

Question 12

What is Wernicke–Korsakoff syndrome (WKS)?

Answer 12

Combined presence of Wernicke encephalopathy and Korsakoff syndrome

Due to the close relationship between these two disorders, people with either are usually diagnosed with WKS as a single syndrome

Question 13

What are the main symptoms of Wernicke–Korsakoff syndrome?

Answer 13

Vision changes, ataxia, memory impairment

Question 14

What is ataxia?

Answer 14

Lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements

Question 15

Who is most likely to suffer from Wernicke–Korsakoff syndrome?

Answer 15

Alcoholics

Question 16

What is the prognosis for Wernicke–Korsakoff syndrome?

Answer 16

Failure in diagnosis of WE and thus treatment of the disease leads to death in approximately 20% of cases, while 75% are left with permanent brain damage associated with WKS

Of those affected, 25% require long-term institutionalization in order to receive effective care

Question 17

What is the role of thiamine?

Answer 17

Essential cofactor in glucose metabolism

Question 18

What brain area does thiamine deficiency mainly affect?

Answer 18

Mammillary bodies

Also the thalamus, the periaqueductal grey, the walls of the 3rd ventricle, the floor of the 4th ventricle, the cerebellum, and the frontal lobe

Question 19

Where is thiamine absorbed?

Answer 19

Duodenum, can be stored in liver for 18 days

Question 20

Vision changes, ataxia, memory impairment; what disorder are you thinking of?

Answer 20

Wernicke–Korsakoff syndrome