Wernicke encephalopathy

Wernicke encephalopathy is a neurological disorder characterized by a triad of symptoms: mental confusion, oculomotor dysfunction, and gait ataxia. It is caused by a deficiency in thiamine (vitamin B1), often associated with alcoholism and malnutrition.

Etiology

The primary cause of Wernicke encephalopathy is thiamine deficiency. Thiamine is an essential nutrient that plays a key role in carbohydrate metabolism and neuronal function. The most common cause of thiamine deficiency is chronic alcoholism, but it can also occur in individuals with malnutrition due to conditions such as anorexia nervosa, gastric bypass surgery, and AIDS.

MRI FLAIR sequence Wernicke Encephalopathy

Pathophysiology

Thiamine deficiency disrupts the Krebs cycle, leading to a decrease in the production of adenosine triphosphate (ATP). This results in an energy crisis in the brain, leading to neuronal death and the symptoms of Wernicke encephalopathy. The areas of the brain most affected are the mammillary bodies, medial thalamus, periaqueductal gray, and superior cerebellar vermis.

Clinical Presentation

The classic triad of symptoms in Wernicke encephalopathy is mental confusion, oculomotor dysfunction, and gait ataxia. However, not all patients present with all three symptoms. Other symptoms may include nystagmus, hypothermia, and hypotension. If left untreated, Wernicke encephalopathy can progress to Korsakoff syndrome, a chronic and debilitating condition characterized by memory loss and confabulation.

Diagnosis

Diagnosis of Wernicke encephalopathy is primarily clinical, based on the presence of the symptom triad and a history of risk factors such as alcoholism or malnutrition. Magnetic resonance imaging (MRI) can show characteristic changes in the affected areas of the brain, but these are not always present. Thiamine levels can be measured, but these are not always reliable as they can be normal in up to 50% of patients with the condition.

Treatment

Treatment for Wernicke encephalopathy involves immediate administration of thiamine. This is typically given intravenously in a hospital setting. In addition to thiamine replacement, treatment of the underlying cause of the deficiency, such as alcoholism or malnutrition, is necessary to prevent recurrence of the condition.

See Also

• Korsakoff syndrome
• Thiamine deficiency
• Alcoholism
• Malnutrition

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