What is the prognosis of Wernicke encephalopathy (WE)?

Updated: Nov 20, 2018
  • Author: Philip N Salen, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Answer

WE is a significantly disabling and potentially lethal condition that can be prevented or reversed if identified and treated early in the course of illness. Administration of thiamine improves the patient’s condition to some degree in many cases; however, neurologic dysfunction can persist even after treatment. [5] WE ataxia and ophthalmoplegia usually resolve briskly, within hours, after thiamine repletion if administered early in the disease course; the global confusional state also appears to improve rapidly within hours of thiamine treatment. However, impairment of memory and learning responds more slowly and often incompletely, suggesting a different mechanism of effect. [6]

WE patients have significant morbidity and mortality related to their thiamine deficiency, particularly if there are no early signs of neurologic improvement after thiamine repletion. Among patients surviving WE, a percentage develop WKS. Patients with Korsakoff psychosis often have permanent neurological disability and require long-term institutionalization. Only about 20% eventually recover completely during long-term follow-up care.

Persistent residual manifestations of WE that are not identified and treated early in the disease include nystagmus, gait ataxia, and Korsakoff syndrome. [5]

Late-stage WE is associated with elevated spinal fluid protein levels and diffuse slowing of postsynaptic potentials on electroencephalography. [7]

Studies suggest that up to 80% of patients with WE may not be diagnosed, which make estimates of morbidity and mortality rates unreliable. [10]


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