Wernicke Encephalopathy

A life-threatening complication of thiamine (vitamin B1) deficiency. Immediate treatment is required to minimise irreversible progression to Korsakoff syndrome.

At-risk groups

• Alcohol dependence (the most common context)
• After bariatric surgery
• Hyperemesis gravidarum
• AIDS / severe malnutrition

Clinical features

Classic triad — ophthalmoplegia + ataxia + confusion (all three present in a minority; treat on any single feature in an at-risk patient).

• Ophthalmoplegia — may begin with nystagmus, progressing to lateral rectus weakness and conjugate gaze palsy.
• Ataxia — gait predominant.
• Confusion / encephalopathy.

Korsakoff syndrome is the chronic complication (often unmasked once the acute delirium lifts):

• Anterograde and retrograde amnesia
• Confabulation

Management

High-dose IV thiamine — give before/with any glucose (glucose without thiamine can precipitate Wernicke’s in a deficient patient):

• 200–500 mg IV three times daily for 5–7 days, then
• 100 mg IV daily for 1–2 weeks (or 100 mg IV TDS for 1–2 weeks), then
• 100 mg orally daily long-term.