Wernicke’s Encephalopathy

Wernicke’s Encephalopathy – General Information

Wernicke’s Encephalopathy is a serious disease which is characterized by a deficiency of vitamin B-1 (thiamine). It causes a large number of signs and symptoms and a lot of mental and psychological complications, such as confusion, memory loss, ataxia and confabulation. The reports have shown that this disorder is quite common in the case of alcoholics, those who have nutrition problems, those who suffer from AIDS or those who are administrated hemodialysis for a long period of time. The bad part about Wernicke’s Encephalopathy is the fact that it is quite difficult to diagnose and this is the reason why the statistics are usually irrelevant. The thiamine is an essential agent which plays an extremely important role inside the human body; it takes part in 3 enzymes systems and when the level of thiamine is quite low the cells begin to die. When this starts to happen, the sufferer starts to experience severe problems of the nervous system, abnormalities of the metabolism of the glucose and the lipids and abnormalities of the process of producing branched chain amino-acids. The frequency rate in the case of Wernicke’s Encephalopathy is about two times higher in the case of alcoholics than in the case of those with no drinking problems. However, the appearance of the disease can also be influenced by the presence of other medical conditions. In addition, the reports have shown that this disease is far more common in the less developed countries, where malnutrition is a widespread problem which leads to thiamine deficiency.

Wernicke’s Encephalopathy - Symptoms

Wernicke’s Encephalopathy is characterized by the appearance and development of three major complications: ataxia gait, encephalopathy and oculomotor dysfunction. Considering these complications, the doctors have established the common signs and symptoms which a patient may experience in the case of this disorder. The signs which have been reported in most of the cases are the following: acute confusion, ataxia, memory disturbance, decreased conscious, hypotension, delirium, opthalmoplegia. In the case of a more complicated form of the disease, the sufferer may even experience psychosis, which is characterized by a delayed and even irreversible amnesia.

The ocular complications which a patient who suffer from this disease can experience consist of nystagmus, ptosis, anisocoria, scotomata or bilateral rectus palsies. Encephalopathy is described by the following: disinterest, agitation, a general confusional state, inattentiveness or even stupor and coma. The gait ataxia is a combination of cerebellar damage, polyneuropathy and vestibular paresis. These combined complications can result in hearing loss and impossibility of walking. Other problems which can indicate the presence of Wernicke’s Encephalopathy are hypothermia, hypertension agitation, lack of appetite, grunting, convulsions and cardio-myopathy. There are some common causes which can lead to the appearance of this disorder and which should be taken into consideration when the doctor establishes a diagnosis. The most common one is a prolonged alcohol abuse which can reduce the intestinal absorption of thiamine with more than 50%. The alcohol abuse becomes even more dangerous when it is associated with malnutrition, an inadequate diet, chronic renal failure, self-imposed starvation or protracted vomiting.

Wernicke’s Encephalopathy – Treatment

As those who suffer from Wernicke’s Encephalopathy present a large number of neurological abnormalities which can also indicate other diseases, the doctor has to perform a careful examination in order to obtain the right diagnosis. In order to do so, the doctor has to ask questions about the patient’s medical history, his general health condition and he should also perform a physical examination, combined with a radiographic evaluation. At this stage, there are available no laboratory tests in order to diagnose Wernicke’s Encephalopathy. In addition to these measures, the doctor can recommend the patient some tests in order to eliminate coexisting or alternate medical conditions. For example, a blood test can exclude the possibility of leukemia and anemia, the determination of the level of serum glucose in the blood can exclude hyperglycemia and hypoglycemia and other medical conditions which are characterized by neurological complications. However, even if the doctor does not obtain sure results, he should administrate the patient thiamine supplements, as a preventive measure.

Apart from the administration of thiamine supplements, in the first stage the doctor has to stabilize the patient’s condition, by ensuring oxygen and maintaining a normal blood pressure. After these measures are taken, the doctor has to choose as soon as possible, the best way of treatment for each patient who suffer from Wernicke’s Encephalopathy, as this disease is considered a medical emergency. The bad part about this disease is the fact that it is reversible and, in some cases, the treatment can not influence the further evolution of the disorder and a possible reappearance. The dosage of thiamine should be adjusted considering each patient’s condition and the gravity of the signs and symptoms; the dose is usually higher in the case of alcoholics and those who suffer from malnutrition. The thiamine solution should always be fresh, as an old one may be inactive. The best thing about the administration of thiamine supplements is the fact that signs and symptoms, such as confusional state and ataxia disappear in a short period of time. In the case of those who suffer from Wernicke’s Encephalopathy and have a poor diet, the doctor should also recommend the administration of glucose supplements and magnesium supplements.  

In most of the cases, the patient should consult not only his personal doctor, but also a neurologist and a physiatrist in order to talk about the neurological complications he may experience. In the case of those who present drinking and eating problems, the doctor should recommend them to talk with some specialized people and become members of a support group. However, the most important thing in the case of those who suffer from Wernicke’s Encephalopathy is how they change their lifestyle after the treatment; they should avoid to consume alcohol and they should follow a strict and balanced diet. Another important factor is the support that patients receive from their friends and family. If the follow-up steps are not followed exactly, the patient may experience one of these complications: korsakoff psychosis, congestive heart failure or an acute reappearance of the disease.