Brief overview
- Diagnosis: medical history, especially regarding alcohol abuse or eating disorders, based on symptoms, magnetic resonance imaging of the head, brain waves, blood test (vitamin B1 level).
- Symptoms: Neurological deficits, disturbances in movement coordination, gait unsteadiness, visual disturbances, mental deficits, disorientation, confusion, restlessness, tremors, great need for sleep.
- Treatment: Administration of vitamin B1 preparations in higher doses once and lower doses over a longer period of time, possibly preventive administration.
- Prognosis: If left untreated, Wernicke’s encephalopathy often leads to death; with treatment, many of the symptoms disappear, but permanent neurological-motor or psychological damage is possible.
- Prevention: If risk is known, preventive administration of vitamin B1; early treatment of risk factors such as alcoholism or eating disorders.
As a result of Wernicke’s encephalopathy, various signs of illness occur that affect the nervous system (neurological symptoms). Together with Wernicke’s encephalopathy, the so-called Korsakow syndrome often occurs – the joint occurrence of several typical symptoms (for example, disorders of short-term or long-term memory, fabrication). Doctors then often speak of a Wernicke-Korsakow syndrome.
How can Wernicke’s encephalopathy be diagnosed?
If a patient presents to a physician with the classic symptoms of Wernicke’s encephalopathy, the physician may already suspect a Wernicke’s encephalopathy based on the patient’s description and specific inquiries. Since time is an important factor in the treatment of Wernicke’s encephalopathy, it is advisable to initiate this treatment already when there is a suspicion and before the diagnosis is one hundred percent certain.
With an additional blood test after the start of treatment with vitamin B1, the physician definitively confirms the diagnosis of Wernicke’s encephalopathy: If the values for certain blood markers, which indicate a vitamin B1 deficiency, deviate strongly from the values of the first blood test, this is the “proof” that Wernicke’s encephalopathy is indeed present.
What are the symptoms?
In addition, there are often visual disturbances resulting from problems with eye coordination and movement of the eye muscles. In addition, people with Wernicke’s encephalopathy often have a faster heartbeat, lowered body temperature and an excessive need for sleep.
Patients are often no longer able to think clearly, absorb information and/or retain it. In addition, a so-called tremor often occurs, which manifests itself by trembling, for example of the hands.
Persons with Wernicke-Korsakow syndrome often try to cover up memory lapses with invented facts. In addition, memory performance is again significantly impaired in Korsakow syndrome.
Causes and risk factors
The permanent lack of vitamin B1, which plays an important role in the energy metabolism of the cell, among other things, damages the nerve cells of the brain, causing them to become increasingly impaired and eventually die. This then usually leads to the brain no longer performing certain tasks as usual, for example movement or eye coordination.
People with eating disorders who follow a very strict diet for long periods of time, up to and including complete abstinence from food, and/or who regurgitate the food they have eaten, often also consume far too little or no vitamin B1 at all.
There are also known cases in which a mistake in the production of baby food (for example in Israel in 2003) in which vitamin B1 was missing, led to Wernicke’s encephalopathy in infants.
Treatment
If there is a risk that a patient will develop a severe vitamin B deficiency again in the future, the physician usually recommends taking vitamin B1 preparations as a preventive measure. This risk exists especially if the underlying cause of Wernicke’s encephalopathy persists.
Course of the disease and prognosis
In Wernicke’s encephalopathy, how quickly treatment is given is critical. With timely treatment, many symptoms such as visual disturbances and clouding of consciousness usually resolve within a short time. Movement disorders usually take several weeks to disappear. In around four out of ten cases, motor impairments remain permanently, and three quarters of patients retain mental impairments.
Prevention
Wernicke’s encephalopathy can be prevented by treating known risk factors. These include, in particular, alcoholism and eating disorders. People at risk should check with their doctor whether it is advisable for them to take vitamin B1 supplements as a preventive measure.
A normal lifestyle does not result in a nutritional vitamin B1 deficiency leading to Wernicke’s encephalopathy. Vitamin B1 is found in many plant and animal foods, and the daily requirement is around one milligram per day, depending on age and gender.
