How is Wernicke encephalopathy (WE) diagnosed?

Updated: Nov 20, 2018
  • Author: Philip N Salen, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Patients with WE present with altered mental status and other neurologic abnormalities. Obtaining a detailed patient history, performing a detailed physical examination with a focus on the neurological exam, laboratory workup, and radiographic evaluation are essential to exclude other causes of central nervous system (CNS) dysfunction.

The clinical diagnosis of WE in alcoholics requires two of the following four signs: (i) dietary deficiencies (ii) eye signs, (iii) cerebellar dysfunction, and (iv) either an altered mental state or mild memory impairment. Sensitivity of the classic triad was 23%, but rose to 85% if the patients had at least two of the four following features: dietary deficiencies, eye signs, cerebellar signs, and either mild memory impairment or an altered mental state. [1]

No specific laboratory test is available for diagnosing WE. WE is a clinical diagnosis, and normal electrolyte levels may give only false reassurance and delay therapy. This is particularly the case when malnutrition is likely to be present. The motto should be "If in doubt, treat," as administration of thiamine does not pose potential harm.

Moreover, neither a normal computed tomography (CT) scan nor a normal magnetic resonance imaging (MRI) scan of the brain rule out the presence of acute WE or chronic WKS. [13]

Although WE remains a clinical diagnosis with no characteristic abnormalities in diagnostic studies, the use of laboratory and radiographic tests remains important to exclude alternate or coexisting medical conditions. The patient’s history and initial evaluation guide the selection of these tests.

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