Wernicke's Encephalopathy

Wernicke's encephalopathy, considered a unique complication of alcoholism, is also seen in malnourished patients, bariatric surgery patients, and patients who have undergone bone marrow transplantation.

Some pearls about Wernicke's encephalopathy:

• The classic triad of confusion, ataxia, and opthalmoplegia is seen in only about 10-15% of cases
• The diagnosis is made before death in only about 10_15% of cases
• Most authorities on the disease have suggested that opthalmoplegia be replaced by ocular, since many ocular findings may be seen in these patients (nystagmus, retinal hemorhages, cranial nerve palsies)
• Essentially any alcoholic who presents with confusion (ever see these patients in your ED?) could have the disease, so give Thiamine liberally when the patient arrives. 
• It is a myth that administration of thiamine before glucose will precipitate Wernicke's. This dogma is based on a case series of 4 patients from the Irish Journal of Medical Sciences.