Noon conference case

1. Noon Conference
Nick Denardin
10/30/2018

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Objectives
Wernicke’s Encephalopathy
• Discuss clinical presentation
• Review diagnostic criteria
• Discuss treatment / what not to do
• Prognosis

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Clinical presentation
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-Classic triad
-Encephalopathy
-Oculomotor dysfunction
-Gait ataxia

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Who Do We See WE In?
Alcoholics
Bariatric surgery patients
Anorexia
Re-feeding syndrome
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Radiologic Findings
Atrophy of mammillary bodies
Neuronal loss in thalamus
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Radiologic findings
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Diagnostic criteria
CLINICAL DIAGNOSIS
2/4 CAINE CRITERIA
1) Dietary deficiency
2) Oculomotor abnormalities
3) Cerebellar dysfunction
4) Altered mental status or memory impairment
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Prevalence at Autopsy
-0.4-2.8% general public
-12% in alcoholics
-29-59% in alcoholic related deaths
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Diagnostic tests
• Folate levels are available at this hospital but
cant be an add on.
• If you wish to look at folate make sure you draw
before you give thiamine.
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Treatment
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GIVE THIAMINE PRIOR TO GLUCOSE LOAD!
-Thiamine safe, simple, inexpensive
-IV thiamine 500mg TID 2days
250mg Qday 5days
PO does not work well due to altered GI absorption in alcoholics

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Prognosis
-Ocular palsies almost always correct
-60% will have permanent nystagmus
-60% permanent ataxia
-80% permanent memory damage
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Remember
Triad
-Encephalopathy, oculomotor dysfunction,
gait ataxia
-Clinical diagnosis  Caine criteria 2/4.
No need for labs and imaging though they
can help.
-Treat with 500mg IV thiamine TID 2 days
then 250mg Qday for 5 days
-Most will not return to normal baseline
following WE
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