EFNS guidelines for diagnosis,therapy and prevention of Wernicke encephalopathy |
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| Authors: | R. Galvin G. Bråthen A. Ivashynka M. Hillbom R. Tanasescu M. A. Leone |
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| Affiliation: | 1. Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland;2. Department of Neurology and Clinical Neurophysiology, Trondheim University Hospital, Trondheim, Norway;3. Department of Neurology, National Neurology and Neurosurgery Research Center, Minsk, Belarus;4. Department of Neurology, Oulu University Hospital, Oulu, Finland;5. Department of Neurology, Colentina Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania;6. Clinica Neurologica, Azienda Ospedaliero‐Universitaria Maggiore della Carità, Novara, Italy |
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| 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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| Keywords: | alcoholism diagnosis guidelines prevention thiamine treatment Wernicke encephalopathy |
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