Wernicke's encephalopathy
| Headline | |
|---|---|
| Etiology | Any thiamine (Vit B1) deficiency including Eating disorders/starvation, although alcohol is the stereotypical cause. Don't forget other causes like Hyperemesis gravidarum... |
| Epidemiology | |
| Clinical presentation | Classic triad: 1. encephalopathy 2. oculomotor dysfunction (nystagmus, lateral rectus, conjugate gaze palsy) 3. gait ataxia (although not necessarily all at once) |
| Pathogenesis | haemorrhage and necrosis in mamillary bodies of thalamus |
| Diagnostic investigations | |
| Management | IV Thiamine (or Pabrinex if you have it...) Followed by PO thiamine until no longer at risk Give thiamine before glucose |
Caine - diagnostic criteria for Wernicke's
At least two of:
- Dietary deficiencies
- oculomotor abnormalities
- cerebellar dysfunction
- and either an altered mental state or mild memory impairment
Korsakoff syndrome
progression of above
anterograde (no new memories) + retrograde amnesia → confabulation
i.e. serious neurocognitive disability!
lesions in the dorsomedial nucleus of the thalamus
clinical presentation: confabulation