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Eur J Neurol. 2010 Dec;17(12):1408-18. doi: 10.1111/j.1468-1331.2010.03153.x.

EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy.

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1
Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland.

Abstract

BACKGROUND:

Although Wernicke encephalopathy (WE) is a preventable and treatable disease it still often remains undiagnosed during life.

OBJECTIVES:

To create practical guidelines for diagnosis, management and prevention of the disease.

METHODS:

We searched MEDLINE, EMBASE, LILACS, Cochrane Library.

CONCLUSIONS AND RECOMMENDATIONS:

1 The clinical diagnosis of WE should take into account the different presentations of clinical signs between alcoholics and non alcoholics (Recommendation Level C); although prevalence is higher in alcoholics, WE should be suspected in all clinical conditions which could lead to thiamine deficiency (good practice point - GPP). 2 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 (Level B). 3 Total thiamine in blood sample should be measured immediately before its administration (GPP). 4 MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B). 5 Thiamine is indicated for the treatment of suspected or manifest WE. It should be given, before any carbohydrate, 200 mg thrice daily, preferably intravenously (Level C). 6 The overall safety of thiamine is very good (Level B). 7 After bariatric surgery we recommend follow-up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation (GPP). 8 Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room (GPP). 9 Patients dying from symptoms suggesting WE should have an autopsy (GPP).

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