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Wernicke’s encephalopathy is a condition that affects the brain. The main cause of this condition is alcohol abuse.

In this page, we will go through the symptoms and diagnosis of Wernicke’s encephalopathy (‘WE’). We will then discuss the main components of treatment for this condition. Finally, we will take a brief look at Korsakoff’s syndrome, a related condition which can develop after WE.

What is Wernicke’s encephalopathy?

Wernicke’s encephalopathy is damage to the brain caused by thiamine deficiency. It causes confusion, problems with sight, and difficulty walking.

Wernicke’s encephalopathy is part of Wernicke-Korsakoff syndrome. Korsakoff syndrome is caused by thiamine deficiency and tends to appear after WE. Its symptoms are slightly different.

This page is going to focus on WE, rather than Korsakoff syndrome, as WE are more treatable. We will, however, discuss Korsakoff syndrome and whether it can be treated later on.

The role of thiamine

Thiamine is essential to cells. It helps them turn carbohydrates into energy. This is one of the most important processes for our survival.

Unfortunately, humans cannot produce thiamine. We, therefore, need to get it from food. Food sources that contain thiamine include peas, soybeans, pork and whole grains. (We’ll go over these in more detail in the ‘Prevention’ section).

Thiamine is crucial to most of our major organs, including the brain, heart, kidney and liver. If they don’t get enough thiamine, it causes serious problems.

Although the heart, kidney and liver can get by with lower levels of thiamine, the brain cannot. Its cells start to deteriorate. This is what causes most of the symptoms of WE, such as confusion and problems with vision.

What are the symptoms of Wernicke’s encephalopathy?

WE can cause a range of symptoms. They include:

  • Altered mental status
  • Confusion
  • Difficulty walking
  • Double vision
  • Droopy upper eyelids
  • Jerky or involuntary eye movements (nystagmus)
  • Memory loss
  • Poor balance
  • Vision problems

People with WE may also be underweight. Issues with body temperature, heart rate and blood pressure can also occur.

It should be noted that the symptoms of people with WE vary from person to person. This is one of the challenges which doctors face when diagnosing this condition.

What are the causes of Wernicke’s encephalopathy?

The main cause of WE is serious, long-lasting alcohol abuse.

However, it can also be caused by an inability to absorb nutrients, poor nutrition, or fasting.

There are a few reasons why heavy drinking is the main cause of WE. The biggest one is that alcohol stops nutrients from being absorbed into the blood by damaging the liver. Thiamine is a nutrient, and when the body cannot absorb it, that creates a deficiency.

Another reason why alcohol abuse can lead to WE is poor diet. Those who abuse alcohol tend to eat less nutritious food. If you eat food that contains fewer nutrients, you are more likely to develop a deficiency. If, on top of that, your body absorbs fewer nutrients due to alcohol intake, the risk of a deficiency is even worse.

That’s why those who abuse alcohol are at risk of a range of deficiencies, including folate, vitamin A and vitamin B6.

Some other risk factors for developing WE include:

  • Anorexia, bulimia, and other eating disorders
  • Chronic infection
  • Extreme diets or fasting
  • Kidney dialysis
  • Late-stage cancer
  • Recent surgery for obesity
  • Severe and persistent vomiting
  • Stage-3 HIV

Can you treat Wernicke’s encephalopathy?

In a word, yes. Korsakoff’s syndrome, which comes after WE, is more difficult to treat. However, as WE come first, if you can diagnose this early and treat it, you can prevent the development of Korsakoff’s.

The key to treating Wernicke’s is thiamine. Wernicke’s is caused by a thiamine deficiency, so this needs to be replaced.

If caught early, and treated effectively, it can take as little as a few days for WE to be reversed. The patient needs to be taken to hospital as soon as WE is suspected, and put on a thiamine drip. Provided the damage is not too severe, they can be cured very quickly.

What are the issues with diagnosing Wernicke’s encephalopathy?

One of the unfortunate things about WE is that it is hard to diagnose. This is a problem because speedy diagnosis is necessary for treatment to be effective.

Diagnosis is difficult for two reasons. The first is that people who regularly abuse alcohol are unlikely to go in for treatment. They may need to be persuaded to do so by a loved one. If they have WE, the damage done to their brain may be severe by the time they seek out treatment.

The second issue is that the symptoms of WE are easily confused with the symptoms of being drunk. Confusion, difficulty seeing and memory loss are all symptoms which someone with an alcohol dependency problem would experience regularly. They might not be able to tell that anything different is going on.

The same can be said of their doctor. Someone who works at A&E might be used to seeing a person in an intoxicated state. They might easily misdiagnose a case of WE as intoxication or a hangover.

NICE has created some guidelines for helping medical staff to diagnose WE. [1] These have helped improve the rates of diagnosis. However, there is still progress to be made.

Things to bear in mind about treatment for Wernicke’s encephalopathy

In this section, we’re going to go over a few general points about treating WE.

The first point to bear in mind is that the sooner treatment begins, the better the chances of curing WE. WE is essentially brain damage. It is a medical emergency which needs to be treated as soon as it is diagnosed.

Another important point is that it may be worth treating for WE even if not all signs and symptoms are present. This is especially true if the patient is high-risk (see above for risk factors).

One final point concerns the way in which thiamine is administered. Giving patients thiamine is the only way to treat WE. This should be done intravenously. Those who are at risk of WE are likely to have an alcohol abuse disorder. This will make it harder for them to absorb nutrients orally.

Stages of Wernicke’s encephalopathy treatment

1. Diagnosis

As mentioned already, one of the hardest things about treating WE is diagnosing it. Doctors should be on the lookout for any giveaway symptoms, such as droopy eyelids or jerky eye movements. They should also be aware that anyone with an alcohol use disorder is at risk.

As soon as WE is diagnosed, treatment must happen. WE is a medical emergency and needs to be treated as such.

2. Hospitalisation

Someone who has been diagnosed with WE needs to go to hospital. There, they will be given regular thiamine injections. This should continue until symptoms improve.

For malnourished patients, a regular glucose injection may also be necessary. Dextrose should be avoided. It can make cell death happen even faster. [2]

While in hospital, doctors and nurses should monitor the patient to see if any more symptoms appear. They should also watch out for symptoms of Korsakoff syndrome.

3. Post-hospital care

After leaving the hospital, the person with WE will need to abstain from alcohol. They will also need to make sure that their diet is healthy. Finally, they will need to take thiamine supplements. This is to slow the development of WE.

Korsakoff syndrome

As we talked about earlier, WE is the first part of Wernicke-Korsakoff Syndrome. Unfortunately, as many as 85 percent of WE cases end up in Korsakoff syndrome. [3]. The outcomes for those with Korsakoff syndrome are worse than for those with WE.

So what exactly is Korsakoff’s? It’s a similar condition to WE, but the symptoms are slightly more severe. They affect the memory even more than WE. Korsakoff syndrome may leave sufferers with large gaps in their memory. They may not be able to remember a conversation that took place very recently.

They may also experience something called ‘confabulation’. This is when the brain creates memories to fill gaps in its knowledge. Someone with Korsakoff syndrome may be convinced that something happened, even if it did not.

It is possible for Korsakoff syndrome to develop without WE, but most of the time Korsakoff syndrome comes after WE.

Furthermore, scientists have noticed that the symptoms of WE tend to go away as the symptoms of Korsakoff syndrome become more noticeable. This trend suggests a link between the two diseases.

Can Korsakoff syndrome be treated?

Korsakoff syndrome may get better over time, but it is believed to be permanent in about a quarter of cases. [4] It is much better to treat WE before it turns into Korsakoff syndrome. As we have discussed, WE is very treatable, if it is spotted early. Although, of course, spotting this condition early is part of the difficulty.

Outcomes

For Wernicke-Korsakoff syndrome, the outcomes are as follows: 25 percent of people make a full recovery, 50 percent recover to a lesser extent, and another 25 percent stay the same. [5]

Again, the sooner this disease is diagnosed, the better the outcomes.

Prevention

Given the severity of this disease, it is far better not to develop it at all, if possible. They to doing so is having a healthy diet, with plenty of thiamine. Also, it is important to keep alcohol intake into a minimum.

For those who are at risk of getting Wernicke’s encephalopathy, here are some foods that are rich in thiamine. Try to eat as many of these as possible, and, if your alcohol intake is out of control, seek treatment.

  • Asparagus
  • Enriched rice
  • Lima beans
  • Milk
  • Nuts, including macadamia, pistachio, and brazil nuts
  • Oranges
  • Peas
  • Pork
  • Poultry
  • Seeds, including sunflower, chia, pumpkin, and squash
  • Soy beans
  • Spinach
  • Whole grains
  • Yeast extract

Final thoughts

Wernicke’s encephalopathy is a truly horrible disease. If you or a loved one are suffering from this disease, we wish you all the best. We hope you have found something useful in this page to help you deal with this situation.

References

[1] https://www.nice.org.uk/guidance/cg100/chapter/Recommendations#wernickes-encephalopathy

[2] https://emedicine.medscape.com/article/794583-treatment

[3] https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/korsakoff-syndrome

[4] https://korsakoffs.org/home/what-is-wernicke-korsakoffs-syndrome/

[5] https://www.medicalnewstoday.com/articles/220007#treatment

boris

Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process.