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Wernicke Encephalopathy and Thiamine

Deficiencies in thiamine or Vitamin B1 can result to Wernicke Encephalopathy, a neurological condition characterized by opthalmoplegia, ataxia and acute mental confusion. Association with memory loss indicates the late manifestation of the condition and is then termed as Korsakoff amnestic syndrome or Wernicke-Korsakoff syndrome.

Vitamin B1 or thiamine deficiency is usually associated with chronic alcoholism which affects the body’s ability to absorb and utilize the vitamin. However, in the case of Wernicke encephalopathy, this can occur in non-alcoholic conditions. This includes HIV-AIDS, bariatric surgery, hyperemesis gravidarum and prolonged starvation. It can even occur to healthy infants who are given wrong formulas.

Clinical History

Wernicke encephalopathy is composed of the classic triad: oculomotor dysfunction, ataxic gait and encephalopathy. But, all these components are recognized in only one-third of the cases.

Wernicke encephalopathy should be considered who have evidence of chronic malnutrition or alcoholism and with the association of any of the following: delirium tremens, memory disturbance, opthalmoplegia, ataxia, confusion and hypothermia with hypotension.

The condition should also be considered in individuals with chronic malnutrition presenting altered mental status or confusion.

Aside from long term alcoholism and malnutrition, other conditions associated with Wernicke encephalopathy are: iatrogenic glucose loading, prolonged parenteral nutrition, hyperemesis gravidarum, malignancy, AIDS and other disorders suggestive of impaired nutritional status.

Signs and Symptoms

Ocular symptoms may include nystagmus, conjugate gaze palsies, bilateral lateral rectus palsies, sluggishly reactive pupils, anisocoria, scotomata and pstosis.

Individuals suffering with this condition usually have altered mental status. The encephalopathy is characterized by agitation, inattentiveness, disinterests or global confusional state. Stupor and coma may also be presented, although rare.

Aside from the abovementioned ocular symptoms, adults with Wernicke’s encephalopathy may have some degree of peripheral neuropathy which may include decreased proprioception, foot drop and weakness.

Because of thiamine deficiency, patients may also suffer from gastrointestinal symptoms like lactic acidosis, nausea and vomiting and abdominal pain. 

 

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