Wernicke’s encephalopathy

Etymology: Karl Wernicke

an inflammatory, hemorrhagic, degenerative condition of the brain. It is characterized by lesions in several parts of the brain, including the hypothalamus, mammillary bodies, andtissues surrounding the ventricles and aqueducts, double vision, ophthalmoplegia, involuntary and rapid movements of the eyes, lack of muscular coordination, and decreasedmental function, which may be mild or severe. Wernicke’s encephalopathy is caused by a thiamine deficiency and is seen in association with chronic alcoholism. It also occurs asa complication of GI tract disease and hyperemesis gravidarum associated with malabsorption and malnutrition. Also called Wernicke’s syndrome.
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Wernicke’s encephalopathy presenting as acute psychosis after gastric bypass.

J Emerg Med. 2009 Apr 28. [Epub ahead of print]

Source

Emergency Medicine Residency, York Hospital, York, Pennsylvania.

Abstract

Background and Objectives: Patients frequently present to the Emergency Department (ED) with psychiatric complaints. The differential diagnosis for acute psychosis is extensive, and determining a possible etiology requires a thorough history and physical. Small details can help the physician in differentiating organic disease from non-organic disease. Many times patients are thought to be “crazy” without a thorough history and physical being done. Case Report: In this case, the diagnosis hinged on the history of having gastric bypass surgery. A thorough physical examination was performed, and the patient had neurologic findings suggestive of severe thiamine deficiency. The patient’s thiamine level was low. The patient was started on i.v. thiamine and slowly began to recover. Conclusion: Cerebral beriberi, more commonly known as Wernicke’s encephalopathy, is a difficult diagnosis to make in the ED. A thorough neurologic examination is difficult to perform in the ED environment, but it is necessary when trying to determine the etiology of the patient’s altered mental status. The number of patients with Wernicke’s encephalopathy may increase with bariatric surgery becoming more common. This disease can present with a wide variety of findings, and the classic triad is not very common. With this in mind, the physician should have a low threshold for administering thiamine intravenously.

PMID:
19406605
[PubMed – as supplied by publisher]

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