Wernicke's Encephalopathy

FIGURE 1  Fluid-attenuated inversion-recovery image showing mild symmetrical hyperintensity in the bilateral medial thalami (arrows).  From the following article: Wernicke's encephalopathy: beyond alcoholism Robin K Wilson, Ralph W Kuncl and Andrea M Corse Nature Clinical Practice Neurology (2006) 2, 54-58.

Recently the Neurology physicians consulted me about a patient (Mr. X) with Wernicke's Encelphalopathy. They made this diagnosis based on Mr. X's response to iv thiamine -- his clinical symptoms resolved. This was my first consultation of this type in a few years and I had a student observing me (always a good motivator to make sure you know your stuff)  so I reviewed some resources to prepare for the assessment.  The patient's nutrition history supported the diagnosis and although I'm not a physician and therefore am reluctant to refine the diagnosis,  I believe Mr. X had a relative rather than absolute thiamine deficiency. He reported recent significant wt loss (7 kg), decreased intake (1 meal per day), minimal intake of grains, vegetables and fruits, and regular although apparently not excessive alcohol consumption (2 beers or 2 glasses of wine every evening).  Because he has been looking after the needs of an aging family member as well as working fulltime, he has been neglecting his self-care, including diet. There were some other barriers to intake but through discussion, he and his wife came up with realistic solutions based on the ideas and resources I offered to them.

Here are the resources I used in my assessment and counselling:

• Nutritional Neuropathies.  Neurol Clin 25 (2007) 209-255.
• Wenicke's encephalopathy: beyond alcoholism.  Nature Clinical Practice Neurology 2 (2006)  54-58.
  
• Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management.  The Lancet Neurology  (2007) Volume 6, Issue 5  442-455.
• Food Sources of Thiamine   Note: You need a PEN subscription to access this Dietitians of Canada resource.
• Fast and Easy Meal Ideas