Wernicke encephalopathy
Classification & external resources

Thiamine
ICD-10	E51.2
ICD-9	265.1
eMedicine	emerg/642

Wernicke encephalopathy is a severe syndrome characterised by ataxia, ophthalmoplegia, confusion and loss of short-term memory.^[1][2] It is linked to damage to the medial thalamic nuclei, mammillary bodies, periaqueductal, and periventricular brainstem nuclei , and superior cerebellar vermis. in the brain, and is the result of inadequate intake or absorption of thiamine (Vitamin B)^[1] coupled with continued carbohydrate ingestion.^[1] The most common cause of an onset is prolonged alcohol consumption that is sufficient enough to cause a thiamine deficiency. Alcoholics are therefore particularly at risk, but it may also occur due to other causes of malnutrition. Other causes of thiamine deficiency may be found in patients with carcinoma, chronic gastritis, or continuous vomiting.^[3][4] Carl Wernicke -- 1848-1905. ... Wernicke syndrome is an ambiguous term. ... Image File history File links Download high-resolution version (1100x423, 31 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Thiamine ... For the similarly spelled nucleic acid, see Thymine Thiamine or thiamin, also known as vitamin B1, is one of the B vitamins. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... For other uses, see Ataxia (disambiguation). ... Ophthalmoplegia (or opthalmoplegia) is the partial or total paralysis of the eye muscles. ... Short-term memory, sometimes referred to as primary, working, or active memory, is that part of memory which stores a limited amount of information for a few seconds. ... Nuclear groups of the thalamus include: This traditional list does not fit in several places with human thalamic anatomy anterior nuclear group anteroventral nucleus anterodorsal nucleus anteromedial nucleus Superficial (lateral dorsal) medial nuclear group (or dorsomedial nucleus]] parvocellular part magnocellular part midline nuclear group or paramedian paratenial nucleus parventricular nucleus... The mammillary bodies (Latin: corpus mamillare) are a pair of small round bodies in the brain forming part of the limbic system. ... The human brain In animals, the brain (enkephalos) (Greek for in the skull), is the control center of the central nervous system, responsible for behavior. ... For the similarly spelled nucleic acid, see Thymine Thiamine or thiamin, also known as vitamin B1, is one of the B vitamins. ... Vitamin B is a complex of several vitamins. ... Lactose is a disaccharide found in milk. ... Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the drinkers normal personal, family, social, or work life, and may lead to physical or mental harm. ...

Presentation

Wernicke encephalopathy onsets acutely, and usually presents with nystagmus, gaze palsies, ophthalmoplegia (especially of the abducens nerve, CN VI), gait ataxia, confusion, and short-term memory loss. Nystagmus is involuntary eye movement that can be part of the vestibulo-ocular reflex (VOR), with the eyes moving first in the direction of the lesioned side (slow phase) followed by a quick correction (fast phase) to the opposite side or away from the lesioned side. ... Conjugate gaze palsy refers to an inability of both eyes to move in the same direction at the same time. ... Ophthalmoplegia (or opthalmoplegia) is the partial or total paralysis of the eye muscles. ... The sixth of twelve cranial nerves, the abducens nerve is a motor nerve that innervates the lateral rectus muscle and therefore controls each eyes ability to abduct (move away from the midline). ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... Gait Abnormality Persons suffering from peripheral neuropathy experience numbness and tingling in their hands and feet. ... Look up Confusion in Wiktionary, the free dictionary Confusion can have the following meanings: Unclarity or puzzlement, e. ...

The classic triad for this disease is encephalopathy, ophthalmoplegia, and ataxia. Untreated, this condition may progress to Korsakoff's psychosis or coma.^[1][2] Despite its name, Wernicke's encephalopathy is not related to damage of the speech and language interpretation area named Wernicke's area (see Wernicke's aphasia). Instead the pathological changes in Wernicke's encephalopathy are concentrated in the mammillary bodies, cranial nerve nuclei III, IV, VI and VIII, as well as the thalamus, hypothalamus, periaquiductal grey, cerebellar vermis and the dorsal nucleus of the vagus nerve. The ataxia and ophthalmoparesis relate to lesions in the oculomotor (ie IIIrd, IVth, and VIth nerves) and vestibular (ie VIIIth nerve) nuclei. Encephalopathy literally means disease of the brain. ... Ophthalmoplegia (or opthalmoplegia) is the partial or total paralysis of the eye muscles. ... For other uses, see Ataxia (disambiguation). ... Korsakoffs syndrome (aka Korsakoffs psychosis, amnesic-confabulatory syndrome), is a continuum of Wernickes encephalopathy, though a recognised episode of Wernickes is not always obvious. ... For other uses, see Coma (disambiguation). ... Receptive aphasia, also known as Wernickes aphasia in clinical neuropsychology and neologistic jargonaphasia in cognitive neuropsychology, is a type of aphasia caused by neurological damage to Wernickes area in the brain. ... The mammillary bodies (Latin: corpus mamillare) are a pair of small round bodies in the brain forming part of the limbic system. ... A cranial nerve nucleus is a collection of neurons (gray matter) in the brain stem that is associated with one or more cranial nerves. ... The thalamus (from Greek θάλαμος = bedroom, chamber, IPA= /ˈθæləməs/) is a pair and symmetric part of the brain. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ... Periaqueductal gray (PAG; also called the central gray) is the midbrain grey matter that is located around the cerebral aqueduct within the midbrain. ... Part of the structure of animal brains, the cerebellar vermis is a narrow, wormlike structure between the hemispheres of the cerebellum. ... The dorsal nucleus of the vagus nerve (or posterior motor nucleus of vagus) is a cranial nerve nucleus for the vagus nerve that arises from the floor of the fourth ventricle. ...

Treatment

Treatment includes an intravenous (IV) or intramuscular (IM) injection of thiamine, prior to the assessment of other central nervous system (CNS) diseases or other metabolic disturbances. Patients are usually dehydrated, and so rehydration to restore blood volume should be started. If the condition is treated early, recovery may be rapid and complete. An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Intramuscular injection is an injection of a substance directly into a muscle. ... An injection is a method of putting liquid into the body with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body. ... For the similarly spelled nucleic acid, see Thymine Thiamine or thiamin, also known as vitamin B1, is one of the B vitamins. ... A diagram showing the CNS: 1. ... Blood volume is a term describing the amout of blood (including both red blood cells and plasma) in a persons circulatory system. ...

In individuals with sub-clinical thiamine deficiency, a large dose of glucose (either as sweet food etc or glucose infusion), can precipitate the onset of overt encephalopathy. Glucose loading results in metabolic disturbances in the brain that exacerbate the signs and symptoms of encephalopathy, and may trigger cellular processes leading to brain damage. ^[5]. If the patient is hypoglycemic (common in alcoholism), a thiamin injection should always precede the glucose infusion. Hypoglycemia is a medical term referring to a pathologic state produced and usually defined by a lower than normal amount of sugar (glucose) in the blood. ...

See also

• Karl Wernicke
• ataxia
• Beriberi
• human brain
• thiamine
• Korsakoff's syndrome
• Wernicke-Korsakoff syndrome

Carl Wernicke -- 1848-1905. ... For other uses, see Ataxia (disambiguation). ... Beriberi is a nervous system ailment caused by thiamine (vitamin B1) deficiency. ... The human brain controls the central nervous system (CNS), by way of the cranial nerves and spinal cord, the peripheral nervous system (PNS) and regulates virtually all human activity. ... For the similarly spelled nucleic acid, see Thymine Thiamine or thiamin, also known as vitamin B1, is one of the B vitamins. ... Korsakoffs syndrome (Korsakoffs psychosis, amnesic-confabulatory syndrome), is a degenerative brain disorder caused by the lack of thiamine (vitamin B1) in the brain. ... Wernicke-Korsakoff syndrome is a combination of Korsakoffs syndrome, which is characterized by confusion, severe anterograde and retrograde amnesia and confabulation; and Wernickes encephalopathy, which is characterized by nystagmus, ophthalmoplegia, coma and, if untreated, death. ...

References

External links

• The Merck Manual, Amnesias - Wernicke's encephalopathy