Nonalcoholic Wernicke's encephalopathy: a retrospective study of 17 cases

J Int Med Res. 2019 Oct;47(10):4886-4894. doi: 10.1177/0300060519870951. Epub 2019 Sep 10.

Abstract

Objective: Nonalcoholic Wernicke’s encephalopathy (WE) is a devastating neuropsychiatric syndrome caused by thiamine deficiency. Although many case reports on WE have been published, more studies are required to guide the diagnosis and treatment of nonalcoholic WE.

Methods: We retrospectively studied patients who were diagnosed with WE in our hospital. Data on demographics, possible causes, phenomenology, and diagnostic and treatment delays were abstracted from medical records by chart reviews.

Results: Seventeen patients were diagnosed with nonalcoholic WE. Nonalcoholic WE had many causes, such as gastrointestinal surgery, gastrointestinal tract diseases, vomiting, and psychiatric diseases. Most patients presented with abnormal mental symptoms, including those in a coma.

Conclusion: In summary, we recommend using operational criteria to diagnose and treat nonalcoholic WE as early as possible to avoid misdiagnosis and treatment delays. Nonalcoholic WE remains a clinical diagnosis, and certain examinations are helpful for this diagnosis, such as measuring serum thiamine concentrations. We should focus on patients who present with abnormal mental symptoms, even those in a coma, and administer parenteral thiamine before any carbohydrate to reduce the high frequency of residual morbidity.

Keywords: Caine criteria; Nonalcoholic Wernicke’s encephalopathy; cerebellar dysfunction; diet; eye signs; thiamine deficiency.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Wernicke Encephalopathy / diagnosis
  • Wernicke Encephalopathy / etiology
  • Wernicke Encephalopathy / pathology*
  • Wernicke Encephalopathy / therapy
  • Young Adult