Wernicke encephalopathy: Difference between revisions
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'''Wernicke encephalopathy''' is "an acute neurological disorder characterized by the triad of ophthalmoplegia, ataxia, and disturbances of mental activity or consciousness. Eye movement abnormalities include nystagmus, external rectus palsies, and reduced conjugate gaze. [[Thiamine]] deficiency and chronic [[alcoholism]] are associated conditions. Pathologic features include periventricular petechial hemorrhages and neuropil breakdown in the diencephalon and brainstem. Chronic thiamine deficiency may lead to [[Korsakoff's syndrome|Korsakoff syndrome]].<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&index=14334 |title=Wernicke Encephalopathy|author=National Library of Medicine |accessdate=2008-01-01 |format= |work=}}</ref> | '''Wernicke encephalopathy''' is "an acute neurological disorder characterized by the triad of ophthalmoplegia, ataxia, and disturbances of mental activity or consciousness. Eye movement abnormalities include nystagmus, external rectus palsies, and reduced conjugate gaze. [[Thiamine]] deficiency and chronic [[alcoholism]] are associated conditions. Pathologic features include periventricular petechial hemorrhages and neuropil breakdown in the diencephalon and brainstem. Chronic thiamine deficiency may lead to [[Korsakoff's syndrome|Korsakoff syndrome]].<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&index=14334 |title=Wernicke Encephalopathy|author=National Library of Medicine |accessdate=2008-01-01 |format= |work=}}</ref> | ||
==Cause/etiology== | |||
Wernicke encephalopathy may occur in the setting of chronic [[alcoholism]],hyperemesis gravidarum<ref name="pmid16551377">{{cite journal |author=Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F |title=Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature |journal=Obstet Gynecol Surv |volume=61 |issue=4 |pages=255–68 |year=2006 |pmid=16551377 |doi=10.1097/01.ogx.0000206336.08794.65}}</ref>, and dialysis<ref name="pmid11684545">{{cite journal |author=Hung SC, Hung SH, Tarng DC, Yang WC, Chen TW, Huang TP |title=Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients |journal=Am. J. Kidney Dis. |volume=38 |issue=5 |pages=941–7 |year=2001 |pmid=11684545 |doi=}}</ref>. | |||
==Diagnosis== | ==Diagnosis== | ||
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===MRI=== | ===MRI=== | ||
The MRI may show enhancement of mamillary bodies with gadolinium suggesting reversible cytotoxic edemain 58% of patients.<ref name="pmid17698536">{{cite journal |author=Zuccoli G, Gallucci M, Capellades J, ''et al'' |title=Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients |journal=AJNR Am J Neuroradiol |volume=28 |issue=7 |pages=1328–31 |year=2007 |pmid=17698536 |doi=10.3174/ajnr.A0544}}</ref> | The MRI may show enhancement of mamillary bodies with gadolinium suggesting reversible cytotoxic edemain 58% of patients.<ref name="pmid17698536">{{cite journal |author=Zuccoli G, Gallucci M, Capellades J, ''et al'' |title=Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients |journal=AJNR Am J Neuroradiol |volume=28 |issue=7 |pages=1328–31 |year=2007 |pmid=17698536 |doi=10.3174/ajnr.A0544}}</ref> | ||
==Treatment== | |||
The treatment is thiamine, thiamine tetrahydrofurfuryldisulphide (TTFD). Outcomes are worse if treatment is delayed.<ref name="pmid7306754">{{cite journal |author=Leigh D, McBurney A, McIlwain H |title=Erythrocyte transketolase activity in the Wernicke-Korsakoff syndrome |journal=Br J Psychiatry |volume=139 |issue= |pages=153–6 |year=1981 |pmid=7306754 |doi=}}</ref> | |||
==References== | ==References== | ||
Revision as of 20:30, 2 January 2008
Wernicke encephalopathy is "an acute neurological disorder characterized by the triad of ophthalmoplegia, ataxia, and disturbances of mental activity or consciousness. Eye movement abnormalities include nystagmus, external rectus palsies, and reduced conjugate gaze. Thiamine deficiency and chronic alcoholism are associated conditions. Pathologic features include periventricular petechial hemorrhages and neuropil breakdown in the diencephalon and brainstem. Chronic thiamine deficiency may lead to Korsakoff syndrome.[1]
Cause/etiology
Wernicke encephalopathy may occur in the setting of chronic alcoholism,hyperemesis gravidarum[2], and dialysis[3].
Diagnosis
History and physical examination
Most patients will have absent nystagmus to cold caloric testing.[4]
MRI
The MRI may show enhancement of mamillary bodies with gadolinium suggesting reversible cytotoxic edemain 58% of patients.[5]
Treatment
The treatment is thiamine, thiamine tetrahydrofurfuryldisulphide (TTFD). Outcomes are worse if treatment is delayed.[6]
References
- ↑ National Library of Medicine. Wernicke Encephalopathy. Retrieved on 2008-01-01.
- ↑ Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F (2006). "Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature". Obstet Gynecol Surv 61 (4): 255–68. DOI:10.1097/01.ogx.0000206336.08794.65. PMID 16551377. Research Blogging.
- ↑ Hung SC, Hung SH, Tarng DC, Yang WC, Chen TW, Huang TP (2001). "Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients". Am. J. Kidney Dis. 38 (5): 941–7. PMID 11684545. [e]
- ↑ Ghez C (1969). "Vestibular paresis: a clinical feature of Wernicke's disease". J. Neurol. Neurosurg. Psychiatr. 32 (2): 134–9. PMID 5305749. [e]
- ↑ Zuccoli G, Gallucci M, Capellades J, et al (2007). "Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients". AJNR Am J Neuroradiol 28 (7): 1328–31. DOI:10.3174/ajnr.A0544. PMID 17698536. Research Blogging.
- ↑ Leigh D, McBurney A, McIlwain H (1981). "Erythrocyte transketolase activity in the Wernicke-Korsakoff syndrome". Br J Psychiatry 139: 153–6. PMID 7306754. [e]