Presentation of acute Wernicke's encephalopathy and treatment with thiamine

Abstract

Thirty two cases of acute Wernicke's encephalopathy were observed in a period of 33 months, and prior to the mandatory thiamine enrichment of Australian bread-making flour in 1991. These cases were carefully assessed by multiple tests at specified intervals prior to, and following thiamine administration until discharge from hospital. Structured scoring of neurological signs and symptoms, CT scans, psychometry, nutritional measurements, and liver biopsies were performed. There was variation in the presentation and severity of clinical signs and symptoms and in response to treatment. All patients had alcohol-related liver disease, and the results indicated that fatty liver was important in presentation and in response to treatment with thiamine. Other forms of alcohol related brain damage were present in these patients, most of whom were in the 4th or 5th decade of life and had been drinking beer to excess for more than 20 years.

Diagnosis and treatment of Wernicke's encephalopathy in an in-patient alcohol detoxification unit: a completed audit cycle

“…Significant and rapid resolution of eye signs and confusion has been reported in a sample of 32 patients with acute Wernicke's encephalopathy after treatment with thiamine. 17 Our findings mirror those described previously, in that eye signs including ophthalmoplegia and nystagmus resolved within the second day in a majority of patients with Wernicke's encephalopathy treated with the treatment regimes. Similarly, those presenting with acute confusion and ataxia responded favourably and rapidly to the regime.…”

Wernicke-Korsakoff Syndrome in Hyperemesis Gravidarum: A Case Report and Literature Review

“…4,[32][33][34] The current practice for the treatment of WE has been largely based on several case reports, empiric clinical experience and one RCT. 32,[34][35][36][37][38][39][40][41] According to a Cochrane review, the weight of evidences from case reports and clinical experience do not justify the performance of a placebo-controlled trial. 41 The single RCT by Ambrose et al presents head-on comparisons among the various doses of thiamine, resulting in the best outcomes for participants who received 200 mg/day for two days.…”

Ethanol

“…The triphosphate ester of thiamine (TTP), present in brain, is involved in the modulation of chloride channels. 442 Liver disease further reduces the body pool. [438][439][440] Alcoholics have several reasons to be thiamine deficient.…”