Wernicke–Korsakoff syndrome: Focus on low-threshold diagnosis and prompt treatment in the primary care setting

Abstract

The authors present the case of an inpatient hospitalized at the Veterans Affairs psychiatric unit diagnosed with Wernicke–Korsakoff syndrome to promote awareness of this prevalent yet often underdiagnosed and undertreated condition. Although Veterans present with a unique predisposition for alcohol abuse, it remains problematic in the general population as well. Analysis from 2000 to 2003 reveals alcohol use in the past month in Veterans at 56.6% and 50.8% in comparable non-Veterans. According to the National Survey on Drug Use and Health, it is estimated that of those who are 18 and older, 86.4% have used alcohol, 26.9% have engaged in binge drinking in the past month, 7% engaged in heavy alcohol use in the past month, and 6.2% (15.1 million) carried the diagnosis of alcohol use disorder., The lifetime prevalence of alcohol abuse in the general population is estimated to be between 4.5% and 13.2%. Primary care providers should maintain a high degree of vigilance in evaluating patients for timely diagnosis and prompt treatment of those suspected to have thiamine deficiency. Indeed, Wernicke’s encephalopathy carries a significant level of morbidity and mortality associated with the syndrome, even in cases when it does not present with all of the classic signs. This article aims to raise the primary and ambulatory care provider’s ability to recognize the condition, emphasize a low threshold to treat, and highlight current treatment recommendations.

Thiamine Dosing for the Treatment of Alcohol-Induced Wernicke’s Encephalopathy: A Review of the Literature

“…This patient also received strictly oral thiamine supplementation at a dose of 200 mg daily. 17 Cognition and balance gradually improved, but the patient was found to have a left-beating horizontal nystagmus halfway through his admission. 17 In both of these case reports, findings showed that oral thiamine was not adequate enough to completely stabilize the patient and reverse their symptoms.…”

“…17 Cognition and balance gradually improved, but the patient was found to have a left-beating horizontal nystagmus halfway through his admission. 17 In both of these case reports, findings showed that oral thiamine was not adequate enough to completely stabilize the patient and reverse their symptoms. The transport of oral thiamine across the blood-brain barrier through various mechanisms has been shown to be a slower process when compared with parenteral administration.…”

“…15 As is evident from primary literature and case reports, the administration of oral thiamine alone was insufficient in adequately addressing WE symptoms. 16,17 In a case report presented by Chataway and Hardman, a patient was started on 200 mg of PO thiamine for 12 days. Ten weeks later, the patient was readmitted with a diagnosis of WE and 400 mg of oral thiamine was initiated.…”

Beyond the bowel: Wernicke's encephalopathy as a neurological complication of Crohn's disease: A case report

“…This syndrome was classically described as a clinical triad consisting of altered mental status (i.e., confusion or dementia), ataxia, and nystagmus (or ophthalmoplegia). However, about a third of patients present with this complete triad [1 , 2] . The most common condition associated with WE are chronic alcohol abuse, but it is also important to remember that there are nonalcoholic causes of thiamine deficiency [3] ; these include individuals with malnutrition, schizophrenia, and anorexia nervosa.…”

Avanços no diagnóstico e tratamento da Síndrome de Wernicke-Korsakoff: Uma análise integrativa da literatura

“…A administração intravenosa de tiamina é essencial para reverter os déficits neurológicos agudos associados à encefalopatia de Wernicke e prevenir a progressão para a síndrome de Korsakoff. Além da terapia com tiamina, o suporte nutricional adequado e a abstinência de álcool são componentes essenciais do tratamento a longo prazo (Yoon et al, 2019).…”