Wernickes Encelopathy

Question 1

Aetiology and risk factors of Wernickes encephalopathy

Answer 1

Decreased thiamine can be due to decreased intake, increased demand or malabsorption
Deficiency causes neuronal death in different areas

Risk factors-alcoholism (not eating enough), AIDS/HIV, Bone marrow transplant, gastric bypass surgery
=> mainly alcohol or GI surgery

Question 2

Signs and symptoms of Wernickes encephalopathy

Answer 2

common to see picture of previous GI surgery
Alcoholism and signs of liver issues

Key features:
mental slowing, impaired concentration and apathy
Frank confusion
Occulormotor-gaze palsies, 6th nerve palsies
Ataxia

delirium/psychosis
alcohol dependence,
irritability

Classical triad of Confusion, Occulomotor (fixed gait) and ataxia- gait disturbances

can degrade to Korsakoffs

Question 3

Investigations of Wernickes encephalopathy

Answer 3

CLINICAL RESPONSE TO PARENTERAL THIAMINE

LFT could be high if alcohol related
blood thiamine-Low

LP and MRI/CT-eliminate other pathologies-should be normal

Question 4

Management of Wernickes Encelopathy

Answer 4

IV pabrinex immediatly
Eyes are the first to respond if working- should be quick
ataxia can take a few days

IV pabrinex also for Korsakoffs- 25% improve a lot,25% a little, 50%dont

Question 5

Korsakoffs presentation

Answer 5

Werkickes life-
triad of Confusion/altered mental status
Ophtalmoplegia
Ataxia

but
Anterograde amnesia, especially with recent memory, and confabulation