What Is Wernicke's Encephalopathy?

Wernicke Encephalopathy (WE) or Wernicke-Korsakoff syndrome is a common metabolic encephalopathy of chronic alcoholism and an emergency caused by thiamine deficiency. In the Chinese mental illness classification scheme, WE is classified as a mental disorder caused by alcoholism. Patients diagnosed and treated in time can completely recover, and the fatality rate of WE is 10% -20%. The age of onset of WE ranges from 30 to 70 years, with an average of 42.9 years, with slightly more men.

Basic Information

nickname

Wernicke-Korsakov syndrome

English name

Wernicke encephalopathy

Visiting department

Neurology

Multiple groups

30 70 years old male

Common causes

Vomiting, malnutrition, anorexia nervosa, liver disease, total stomach resection, and malignant tumors caused by thiamine deficiency in pregnant women

Common symptoms

Bilateral abductor nerve palsy and diplopia, mental breakdown, irritability, apathy and dementia, ataxia, etc.

Causes of Wernicke's Encephalopathy

The cause of Wernicke's encephalopathy is thiamine deficiency. The causes of thiamine deficiency include vomiting, malnutrition, anorexia nervosa, liver disease, total gastric resection, malignant tumors, malignant anemia, chronic diarrhea, long-term renal dialysis, and parenteral nutritional deficiency. Thiamine and so on. Animal experiments show that chronic alcoholism can lead to malnutrition, mainly thiamine deficiency, which in turn can worsen chronic alcoholism.

Clinical manifestations of Wernicke's encephalopathy

1. Mainly manifested as sudden onset of nervous system dysfunction, typical WE has three groups of characteristic symptoms of extraocular muscle paralysis, mental abnormality and ataxia.

(1) Extraocular muscle paralysis is commonly caused by bilateral abductor nerve palsy and diplopia. Other eye symptoms may include nystagmus, ptosis, optic disc edema, retinal hemorrhage, and pupil reflex dullness or disappearance; nystagmus occurs early, with horizontal and Verticality is dominant, often accompanied by abnormal vestibular function tests. Ocular muscle paralysis often recovers within 24 hours if treated promptly, and nystagmus needs 1 to 2 weeks to recover.

(2) Mental abnormalities are manifested as attention, memory and disorientation, mental distraction, irritability, emotional apathy, and dementia, etc., which are sometimes difficult to distinguish from the state of abstinence, often referred to as generalized turbidity; often accompanied by Korsakoff syndrome , Characterized by memory impairment, learning disability, fiction, apathy, and disorientation, often with confusion, drowsiness, or coma.

(3) Ataxia is dominated by the trunk and lower limbs, the upper limbs are rare, it is difficult to stand and walk, and it takes 2 weeks or more to recover.

2. Only 10% to 16.5% of patients developed three groups of symptoms, mental disorders, eye symptoms, and ataxia. Most patients are associated with hypothermia, hypotension, and tachycardia, and some patients have complications such as liver disease, heart failure, pancreatitis, and peripheral neuropathy. Ophthalmoplegia recovers quickly, and recovery of mental symptoms often takes weeks to months.

Wernicke Encephalopathy

Laboratory inspection

(1) The determination of blood and urine alcohol concentration has diagnostic significance and assessment of alcoholism.

(2) Other blood tests include blood biochemistry, liver function, kidney function, coagulation function, and immunoglobulin.

2. Other auxiliary inspections

(1) CT examination showed low-density or high-density lesions in bilateral thalamus and brainstem, and 25% of patients had low-density areas around the aqueduct.

(2) MRI is an ideal tool for the diagnosis of WE. Early diagnosis is more sensitive. Symmetric bilateral thalamus and brainstem symptom can be seen. The typical change in the acute phase is the symmetry T ₂ WI high signal in the third ventricle and the aqueduct. 6 After ~ 12 months, the high signal in the recovery period decreases or disappears; papillary body atrophy is a characteristic neuropathological abnormality of WE, and the papillary body volume is significantly reduced.

(3) ECG and EEG tests have significance in differential diagnosis and assessment of poisoning degree.

Wernicke's Encephalopathy Diagnosis

Mainly based on medical history, clinical manifestations, and typical changes in head MRI. Since the typical three groups of WE symptoms are not common, they are difficult to identify even if they appear. They are easily missed and misdiagnosed. Patients with chronic alcoholism or malnutrition with conscious disturbance should be aware of the possibility of WE for early treatment.

Differential diagnosis of Wernicke's encephalopathy

This disease must be distinguished from other symptoms such as cerebral organic dementia, extraocular muscle paralysis, mental disorders and ataxia.

Wernicke Encephalopathy Treatment

1. Etiology treatment is the most important. Patients with chronic alcoholism have gastrointestinal malabsorption. B vitamins have little effect on oral or intramuscular injection. Vitamin B ₁ should be infused intravenously immediately for 2 weeks or until the patient can eat. Early onset, rapid parenteral vitamin B ₁ (thiamine) recovery is complete.

2. Insufficient vitamin B ₁ (thiamine) storage in the body, supplementation with a large amount of sugars can induce typical WE attacks, which is caused by glucose metabolism depletion of vitamin B ₁ (thiamine) in the body. Patients with chronic alcoholism, malnutrition, hypoglycemia, and liver disease accompanied by unconsciousness should receive vitamin B ₁ parenterally before intravenous glucose infusion to prevent the induction of WE. In patients with WE caused by chronic alcoholism, patients may be accompanied by magnesium deficiency. Magnesium deficiency can reduce the effect of thiamine and worsen the condition of thiamine deficiency, so magnesium should be supplemented.

Prognosis of Wernicke Encephalopathy

If WE is not treated in time, the course of disease can continue to progress, and patients with coma, shock, and cardiovascular failure often indicate a poor prognosis.

Wernicke Encephalopathy Prevention

Promote the harm of alcohol to the human body, improve the cultural quality of the entire nation, strictly enforce the law on minors, strictly prohibit minors from drinking, and strengthen legal supervision. Attach importance to and strengthen the mental health propaganda of alcohol, promote civilized drinking, do not persuade, do not drink, do not drink on an empty stomach, treat physical or mental illness, and avoid using alcohol instead of medicine.