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Wernicke encephalopathy

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  • Descripción general
  • Teoría
  • Diagnóstico
  • Manejo
  • Seguimiento
  • Recursos
Última revisión: 11 Aug 2025
Última actualización: 17 Sep 2024

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • history of gastrointestinal (GI) surgery
  • mental slowing, confusion, impaired concentration, and apathy
  • oculomotor signs
  • history of alcohol-use disorder
  • pre-existing conditions that predispose to malnutrition: for example, HIV/AIDS, cancer, anorexia/bulimia, prolonged vomiting, or diarrhea
  • classic triad: mental status changes, ophthalmoplegia, and gait dysfunction
Todos los datos

Otros factores de diagnóstico

  • mild irritability
  • acute psychosis
  • coma
  • miosis, anisocoria, light/near dissociation
  • papilledema, retinal hemorrhages
  • tachycardia or hypotension
  • hypothermia or hyperthermia
  • hearing loss, epileptic seizures, and spastic paraparesis
  • ataxia
Todos los datos

Factores de riesgo

  • alcohol-use disorder
  • HIV infection and AIDS
  • cancer and treatment with chemotherapeutic agents
  • malnutrition
  • history of gastrointestinal (GI) surgery
  • genetic variants associated with altered thiamine metabolism and transport
  • bone marrow transplantation
  • male sex
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • therapeutic trial of parenteral thiamine
  • serum thiamine
  • MRI of brain
  • blood glucose
  • CBC
  • serum electrolytes
  • renal function
  • LFTs
  • toxicology screen
  • serum ammonia
  • blood alcohol level
Todos los datos

Pruebas diagnósticas que deben considerarse

  • lumbar puncture
Todos los datos

Algoritmo de tratamiento

Agudo

suspected Wernicke encephalopathy

En curso

high risk for thiamine deficiency

Colaboradores

Autores

Gregory S. Day, MD, MSc, MSCI, FAAN, FANA, FANA

Associate Professor of Neurology

Division Director, Behavioural Neurology

Mayo Clinic in Florida

Jacksonville

FL

Divulgaciones

GSD declares no competing interests directly relevant to this work. His research is supported by the National Institute of Health (U01AG057195, U01NS120901, U19AG032438). He serves as a consultant for Parabon NanoLabs, Inc. and as a topic editor (Dementia) for DynaMed (EBSCO). He is the co-project principal investigator for a clinical trial in anti-NMDAR encephalitis, which receives support from the National Institute of Neurological Disorders and Stroke (U01NS120901) and Amgen Pharmaceuticals, and a consultant for Arialys Therapeutics. He has developed and edited educational materials for Continuing Education, Inc. and Ionis Pharmaceuticals. GDS owns stock in ANI Pharmaceuticals. His institution has received support from Eli Lilly and Company for development and participation in an educational event promoting early diagnosis of symptomatic Alzheimer disease, and in-kind contributions of radiotracer precursors for tau-PET neuroimaging in studies of memory and aging (via Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly and Company).

Agradecimientos

Dr Gregory S. Day would like to gratefully acknowledge Dr Abhay Moghekar, a previous contributor to this topic. AM is a medical advisory board member of the Hydrocephalus Association and was reimbursed for travel and airfare. AM was a consultant to Quest Diagnostics and Orbees Incorporation for market research, receiving payment for consulting. AM undertook research for Fujirebio Diagnostics and received a research grant to his lab at Johns Hopkins University.

Revisores por pares

Adrian Priesol, MD, FRCPC

Instructor

Massachusetts Eye and Ear Infirmary

Harvard Medical School

Boston

MA

Divulgaciones

AP declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Galvin R, Bråthen G, Ivashynka A, et al. Guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010 Dec;17(12):1408-18.Texto completo  Resumen

Artículos de referencia

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