Wernicke's Encephalopathy – what is it?

TL;DR

Wernicke's encephalopathy is a serious neurological complication of chronic alcoholism, caused by vitamin B1 (thiamine) deficiency, leading to neuronal damage. Physical symptoms include coordination problems, gait disturbances, sensory issues, vision problems (nystagmus, eye movement disorders), as well as seizures and shortness of breath. Psychological symptoms include disorientation, memory problems, consciousness disorders, delirium, personality changes, and emotional apathy. Untreated disease can lead to Wernicke-Korsakoff syndrome, meaning irreversible brain damage with memory gaps filled with confabulations. Diagnosis is based on medical history, neurological and imaging examinations (CT), as well as thiamine level measurement. Treatment involves immediate vitamin B1 supplementation (intravenously or intramuscularly), possibly with magnesium and glucose. Early intervention offers a chance to reverse most symptoms, although some (e.g., ataxia) resolve only after several weeks.

What is Wernicke's encephalopathy?

Wernicke's encephalopathy, also known as Wernicke syndrome or alcoholic encephalopathy, is a set of acute neurological symptoms occurring in people dependent on alcohol. It is associated with vitamin B1 deficiency occurring with chronic alcoholism. This disease was first described in 1881 by German physician, psychiatrist and neurologist Carl Hugo Wilhelm Ernst Wernicke, professor at the University of Wrocław and the University of Halle. Currently, Wernicke's encephalopathy is included in the International Classification of Diseases and Health Problems ICD-10.

Causes of alcoholic encephalopathy

The cause of Wernicke's encephalopathy is chronic alcohol disease. Long-term exposure of the body to ethanol leads to serious health consequences, including deficits in the brain that persist long after sobering up. The direct cause of alcoholic encephalopathy is thiamine deficiency, i.e., vitamin B1. It is caused both by poor nutrition of alcohol-dependent people and by the acceleration of this vitamin's metabolism by ethanol. As a result of thiamine deficiency in the body, changes occur in central and peripheral neurons, and as a result, their death and the appearance of hemorrhages and degenerations.

Wernicke's encephalopathy – symptoms

Symptoms of Wernicke's encephalopathy can be divided into physical and psychological.

Physical symptoms of alcoholic encephalopathy

Physical symptoms of Wernicke's encephalopathy include primarily ailments affecting the musculoskeletal system, such as:

• ataxia, i.e., movement incoordination

• gait disturbances

• impaired gesture precision

• reduced coordination

• sensory disturbances in limbs

• neuralgias and muscle pains

• involuntary movements

• paresis

• myoclonus, i.e., muscle jerks

• muscle spasms

• seizures

• restless legs syndrome

• balance problems

• exertional dyspnea.

In some cases, there is also loss of the ability to walk. Alcoholic encephalopathy also manifests through problems related to the visual organ. During the disease, the following occur, among others:

• nystagmus

• periorbital disorders

• paralysis of eyeball abduction

• disturbances of conjugate eye movements

• blurred or double vision.

One of the symptoms of Wernicke's encephalopathy are disorders related to the visual organ.

Psychological symptoms of alcoholic encephalopathy

Psychological symptoms occurring during Wernicke's encephalopathy are primarily:

• emotional and intellectual degradation

• consciousness and perception disorders

• disorientation

• excessive agitation or apathy

• delirium

• insomnia or excessive drowsiness

• unjustified fear

• memory lapses

• concentration disorders

• difficulty in connecting facts

• spontaneous speech disorders

• mood and personality disorders

• indifference to stimuli

• loss of emotional reactivity.

Fear of darkness that was not present before also frequently appears. A typical symptom of alcoholic encephalopathy is also the inability to find an exit from a room. During the disease, symptoms related to nutrient deficiency also occur. These are primarily skin problems, changes in the oral mucosa and tongue redness, as well as liver failure and disorders in the form of tachycardia and orthostatic hypotension. Untreated Wernicke's encephalopathy can result in the development of Korsakoff's psychosis. The co-occurrence of both these diseases is defined as Wernicke-Korsakoff syndrome. See: Korsakoff syndrome, i.e., amnestic syndrome of alcoholic psychosis

Wernicke-Korsakoff syndrome

People suffering from this syndrome experience symptoms of both Wernicke's encephalopathy and Korsakoff's psychosis, also called amnestic syndrome, i.e., a neuropsychiatric disease that in many aspects resembles amnesia. It manifests through the formation of memory gaps that the sick person tries to fill with imaginary content. Other symptoms that a person suffering from Korsakoff's psychosis must deal with are: retrograde amnesia, i.e., memory loss concerning events before the disease, anterograde amnesia, i.e., memory loss concerning events after the disease, deep impairment of current memory, impairment of executive functions, i.e., those concerning planning, controlling, and regulating one's own behavior. The co-occurrence of Wernicke's encephalopathy and Korsakoff's psychosis can lead to irreversible changes in the human brain. Therefore, implementing appropriate treatment is necessary. Neglecting symptoms and ignoring Wernicke-Korsakoff syndrome can result in permanent complications and in some cases even cause death of the sick person.

What does the diagnosis of Wernicke's encephalopathy look like?

In diagnosing Wernicke's encephalopathy, blood tests are performed that allow determination of vitamin B1 levels in the body, as well as computed tomography of the head, which allows exclusion of other serious neurological conditions such as tumors, bleeding, or stroke. However, the basis for recognizing the disease is the patient's medical history and medical examination. For alcoholic encephalopathy to be diagnosed in a patient, two of the following disease symptoms must be present:

• eye movement disorders

• malnutrition

• ataxia

• memory disorders

• cognitive function disorders.

Wernicke's encephalopathy – treatment

Treatment of Wernicke's encephalopathy should be implemented immediately after the appearance of symptoms characteristic of the disease. It consists primarily of supplementing vitamin B1 deficiency in the body. Thiamine is most often administered intravenously. It also happens that the patient is administered multivitamin preparations intramuscularly. In some cases, simultaneous administration of magnesium, which facilitates absorption of vitamin B1, as well as intravenous fluid replacement, is necessary. After balancing the thiamine level in the patient's body, glucose may also be administered. This substance accelerates vitamin B1 metabolism and promotes return to health. For proper supplementation of deficiencies and full control over the treatment process, hospitalization of the patient diagnosed with alcoholic encephalopathy is usually necessary. Undertaking appropriate treatment, based among others on the use of vitamin infusions, enables elimination of most symptoms of Wernicke syndrome. Their disappearance usually does not take long to wait for. However, it is worth remembering that this does not apply to such disease symptoms as ataxia, nystagmus, and peripheral neuropathy. The disappearance of these symptoms usually occurs only after several days, and sometimes even weeks. Professional detoxification in Lublin offered by our specialists will help eliminate symptoms of alcoholic encephalopathy.

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