Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy.

Abstract

Results-Despite rater variability with regard to specific symptoms, within and between rater reliability for diagnostic classification using the criteria retrospectively on patient records was 100% for three independent raters. Validity testing showed that Wernicke's encephalopathy was underrecognised only when occurring with hepatic encephalopathy (50% sensitivity).Conclusions-By contrast with current criteria, the proposed operational criteria show that the antemortem identification of Wernicke's encephalopathy can be achieved with a high degree of specificity.

Contributions to Understanding the Neuropsychology of Alcoholism: An INS Legacy

“…A decade later, Pitel et al (2011) operationalized the Caine et al criteria for in vivo use in alcoholics and controls; historical interview enumerated missed meals and quantitative examination tested for nystagmus, ataxia, and cognitive compromise determined with the Mattis Dementia Rating Scale (Mattis, 1988). Although no alcoholic presented with any of the three classical WE signs of ophthalmoplegia, ataxia, or delirium, a large proportion of the alcoholic group met one or two criteria, based on Caine et al (1997) and operationalized by Pitel et al (2011). In fact, more than half the group met one criterion; 16% met two criteria; and only approximately one quarter of the group were free of these signs (Figure 3).…”

“…Pursuing these observations, Caine and colleagues devised 4 criteria for chart review of their postmortem cases: evidence for dietary deficiency, oculomotor abnormalities, cerebellar dysfunction, and altered mental state. Cases having two of four of these signs correlated with presence of neuropathological signs of WE (Caine, Halliday, Kril, & Harper, 1997). A decade later, Pitel et al (2011) operationalized the Caine et al criteria for in vivo use in alcoholics and controls; historical interview enumerated missed meals and quantitative examination tested for nystagmus, ataxia, and cognitive compromise determined with the Mattis Dementia Rating Scale (Mattis, 1988).…”

Development and Resolution of Brain Lesions Caused by Pyrithiamine- and Dietary-Induced Thiamine Deficiency and Alcohol Exposure in the Alcohol-Preferring Rat: A Longitudinal Magnetic Resonance Imaging and Spectroscopy Study

“…Alcoholics are at special risk for thiamine deficiency because of the poor diet associated with their lifestyle and because chronic alcoholism compromises thiamine absorption from the gastrointestinal tract, impairs storage, and may reduce thiamine phosphorylation, essential for cellular function (Lieber, 2003a;Martin et al, 2003;Thomson et al, 1987;Todd and Butterworth, 1999). Parenteral thiamine treatment given in the early symptomatic stages largely reverses the classical neurological signs of ophthalmoplegia, nystagmus, ataxia of gait, and amnesia for new information (Caine et al, 1997;Victor et al, 1971Victor et al, , 1989, although severe or undertreated cases may show enduring memory impairment and ataxia defining Korsakoff's syndrome (Butters and Cermak, 1980;Kopelman, 1995;Talland, 1965;Victor et al, 1959). Neuroradiological studies of WE since the 1970s report in vivo signs of hyperintensity in thalamus, periventricular gray matter, inferior colliculi, and occasionally in cerebellum, observations consistent with post-mortem reports (eg, Baker et al, 1999;Kril, 1988, 1990;Kril et al, 1997;Torvik et al, 1982Torvik et al, , 1986, with partial lesion resolution with treatment.…”

Encefalopatía de Wernicke secundario a hiperémesis gravídica: la importancia del diagnóstico temprano

“…En 1997 Caine et. al (15) propusieron cuatro criterios diagnósticos con una sensibilidad del 85% cuando hay presencia de por lo menos dos de ellos: deficiencia en la dieta, anomalías oculomotoras (60.3%), disfunción cerebelosa (82.5%) y estado mental alterado (30.1%) o alteración de la memoria (52.3%) (12,17). Esta propuesta resalta la importancia de la sospecha diagnóstica que el obstetra debe tener ante cualquier paciente con HG y alteración neurológica.…”