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Intern Med J 2019 Apr;49(4):536-539

Neurological Intervention and Imaging Service of WA (NIISwa), Royal Perth Hospital, Perth, Western Australia, Australia.

Wernicke encephalopathy (WE) is a neurological emergency that develops in the setting of thiamine deficiency, and is characterised by symptoms of confusion, ophthalmoplegia and gait ataxia. Less recognised signs and symptoms include vestibular dysfunction, hearing impairment, peripheral neuropathy, and in severe cases, coma. This case study describes a non-alcoholic patient, who presents with significant auditory and vestibular changes in addition to the classic symptoms of WE. Read More

Rozhl Chir Winter 2019;98(2):66-70

The authors report a case study of a 24-year-old female patient after sleeve gastrectomy with subsequent manifestation of Wernickes encephalopa-thy. After 5 weeks following the surgery, which were uneventful, the patient was repeatedly hospitalized in the surgical department for extreme vomiting; however, her health status rapidly improved with infusion therapy followed by careful re-alimentation. At the same time, her GIT was closely examined without any clear finding. Read More

Eur Addict Res 2019 Mar 21;25(3):103-110. Epub 2019 Mar 21.

Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.

Aims: Patients with alcohol use disorder (AUD) frequently suffer from cognitive deficits ranging from mild symptoms to most severe forms. Wernicke encephalopathy (WE), caused by thiamine deficiency, is a potentially fatal syndrome characterized by the clinical triad of ophthalmoplegia, ataxia, and confusion. WE frequently presents in patients with AUD and, if left untreated, can progress to Wernicke-Korsakoff syndrome, which constitutes severe anterograde amnesia, confabulation, and behavioral abnormalities. Read More

Eur J Obstet Gynecol Reprod Biol 2019 Mar 12;236:84-93. Epub 2019 Mar 12.

Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, the Netherlands.

Pregnant women have an increased demand for thiamine. In hyperemesis gravidarum (HG) thiamine rapidly depletes, which can lead to Wernicke's Encephalopathy (WE). Our objective was to systematically review the signs and symptoms of WE in HG. Read More

Medicine (Baltimore) 2019 Mar;98(10):e14808

Department of Physical Medicine and Rehabilitation, China Medical University Hospital.

Rationale: Bariatric surgery is the recommended treatment for morbid obesity because of its rapid and sustained body weight loss effect. Nutrient deficiency-related neurological complications after bariatric surgery are often disabling. Thus, early recognition of these complications is important. Read More

J Neuroophthalmol 2019 Feb 27. Epub 2019 Feb 27.

Department of Ophthalmology (AAS, LBK), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Radiology (JKC), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.

Int J Psychiatry Med 2019 Mar 1:91217419832771. Epub 2019 Mar 1.

1 UCSF Fresno Psychiatry Residency Training Program, Fresno, CA, USA.

The authors present the case of an inpatient hospitalized at the Veterans Affairs psychiatric unit diagnosed with Wernicke-Korsakoff syndrome to promote awareness of this prevalent yet often underdiagnosed and undertreated condition. Although Veterans present with a unique predisposition for alcohol abuse, it remains problematic in the general population as well. Analysis from 2000 to 2003 reveals alcohol use in the past month in Veterans at 56. Read More

J Subst Abuse Treat 2019 Apr 23;99:117-123. Epub 2019 Jan 23.

Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.

Background: Patients with alcohol use disorder (AUD) are at an increased risk of developing Wernicke's encephalopathy (WE), a devastating and difficult diagnosis caused by thiamine deficiency. Even as AUD is present in up to 25% of hospitalized patients on medical floors, appropriate thiamine supplementation in the hospital setting remains inadequate. These patients are particularly susceptible to thiamine deficiency and subsequent WE due to both their alcohol use and active medical illnesses. Read More

J Neurol 2019 Apr 7;266(4):1027-1030. Epub 2019 Feb 7.

Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.

Palliat Support Care 2019 Jan 30:1-3. Epub 2019 Jan 30.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Aichi,Japan.

Objective: Thiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer; however, TD has not been recognized in the family caregivers of cancer patients to date.

Method: From a series of cancer patient caregivers, we reported an aged family caregiver who developed TD while caring for the cancer patient.ResultThe caregiver was a 90-year-old male. Read More

Lakartidningen 2019 01 24;116. Epub 2019 Jan 24.

Skane's University Hospital - Ear, nose and throat clinic Lund, Sweden - Lund, Sweden.

Wernicke encephalopathy is a condition in which thiamine deficiency causes cognitive dysfunction, ataxia and eye motor abnormalities. The condition is potentially reversible if treated with high doses of intravenous thiamine (vitamin B1). The video head impulse test, in which the vestibulo-ocular reflex is tested, can reveal an early specific sign of selective dysfunction in the medial vestibular nuclei by demonstrating selective dysfunction of the horisontal vestibulo-ocular reflex. Read More

Dtsch Med Wochenschr 2019 01 23;144(2):101-107. Epub 2019 Jan 23.

Delirium is a potentially life-threating acute disease accompanied by a mortality up to 30 % of all affected patients. It occurs more frequently in older patients ≥ 65 years. Delirium is defined as acute onset of disturbances in attention, awareness and cognition that develops within a short period of time and fluctuates in severity. Read More

Nutr Clin Pract 2019 Jan 15. Epub 2019 Jan 15.

Internal Medicine Department, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil.

Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. Read More

Noro Psikiyatr Ars 2018 Dec 25;55(4):307-314. Epub 2018 Apr 25.

Department of Neurology, İstanbul Medical Faculty, University of İstanbul, Turkey.

Introduction: Wernicke's encephalopathy (WE) is an underdiagnosed neuropsychiatric disorder especially in non-alcoholic groups that causes morbidity-mortality if diagnosis is delayed. Korsakoff syndrome is a chronic consequence of this condition characterized by persistent memory impairment. In this study we present a series of non-alcoholic patients with WE. Read More

BMJ Case Rep 2019 Jan 3;12(1). Epub 2019 Jan 3.

Department of Internal Medicine, Singapore General Hospital, Singapore.

A 56-year-old teetotaller man with hypertension and gout presented with a week duration of painless worsening diplopia on a background of loss of weight and appetite, generalised lethargy and weakness for 1 year. On examination, he was noted to be hypothermic and tachycardic with generalised muscle wasting. Proximal myopathy, lower limb fasciculations and areflexia, restricted bilateral eye abduction and nystagmus were observed. Read More

BMJ Case Rep 2018 Dec 27;11(1). Epub 2018 Dec 27.

Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA.

Thiamine is an important coenzyme, which is essential for metabolism and maintaining cellular osmotic gradient. Thiamine deficiency can cause focal lactic acidosis, alteration of the blood-brain barrier and the production of free radicals through cell death by necrosis and apoptosis. Wernicke encephalopathy (WE) is a clinical diagnosis. Read More

Acta Medica (Hradec Kralove) 2018;61(3):111-113

Department of Medicine E, Sheba Medical Center, Tel-Hashomer affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.

Duodenal Switch procedure is a type of bariatric surgery that was reserved for severely morbid obese people. Patients undergoing this procedure are at high risk for nutrient deficiencies. In this report we present a case of a patient who had developed polyneuropathy, generalized muscle weakness, Wernicke encephalopathy, myocardial dysfunction and pericardial effusion six years following this operation. Read More

Lakartidningen 2018 12 7;114. Epub 2018 Dec 7.

Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden.

Ann Indian Acad Neurol 2018 Oct-Dec;21(4):328-330

Department of Pathology, Yashoda Superspeciality Hospitals, Hyderabad, Telangana, India.

Rev Assoc Med Bras (1992) 2018 Oct;64(10):882-884

Ph.D. in Surgery, Chief of Bone Marrow Transplantation Service at Walter Cantidio University Hospital - Fortaleza (CE), Brasil.

Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. Read More

Funct Neurol 2018 Jul/Sept;33(3):165-166

Clin Liver Dis 2019 02;23(1):141-155

Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, 7200 Cambridge Street, 9th Floor, MS:BCM609, Houston, TX 77030, USA. Electronic address:

Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions. Once identified, nutritional supplementation and cessation measures are critical in preventing further neurologic damage. The proposed mechanisms of neuronal injury in chronic alcohol abuse include direct toxic effects of alcohol and indirect effects, including those resulting from hepatic dysfunction, nutritional deficiencies, and neuroinflammation. Read More

J Neurol Sci 2019 01 12;396:121-122. Epub 2018 Oct 12.

Pathological Anatomy Unit, Sant'Andrea Hospital, La Spezia, Italy.

Behav Sci (Basel) 2018 Nov 12;8(11). Epub 2018 Nov 12.

EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.

We report atypical magnetic resonance imaging (MRI) lesions in a case of Wernicke encephalopathy. The patient presented with isolated anterograde amnesia following a partial colectomy complicated by peritonitis. Fluid-attenuated inversion recovery and T2 MRI sequences were normal. Read More

Prion 2019 01 14;13(1):13-20. Epub 2018 Nov 14.

a Department of Neuropathology, Institute for Medical Science of Aging , Aichi Medical University , Nagakute , Japan.

An 83-year-old Japanese man presented with gait disturbance followed by rapidly-progressive cognitive impairment. Magnetic resonance diffusion-weighted images showed extensive hyperintense regions in the cerebral cortex. Four weeks after symptom onset, myoclonus appeared, and the patient developed difficulty swallowing; intravenous peripheral continuous infusions without vitamin supplementation were administered during the last two months of the patient's life. Read More

Neuropsychiatr Dis Treat 2018 8;14:2593-2598. Epub 2018 Oct 8.

Department of Psychiatry, Consultation-Liaison Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA,

This case discusses the course of a woman with a history of epilepsy, alcohol use disorder, herpes simplex virus (HSV) encephalitis, and Wernicke encephalopathy (WE) who presented with altered mental status following approximately 48 hours of vomiting. After experiencing a tonic-clonic seizure in the emergency department, she developed a fluent aphasia. Aphasias are ordinarily attributed to structural changes in the brain parenchyma, often from stroke, neoplasm, or infection. Read More

Neurology 2018 Oct;91(17):790-796

From the Department of Neurology (J.C.K., A.S.T.), University of Illinois College of Medicine; Illinois Neurologic Institute (J.C.K., A.S.T.), Peoria; Departments of Otolaryngology-Head and Neck Surgery (S.d.L., D.E.N.-T., D.S.Z.), Neuroscience (S.d.L., D.E.N.-T., D.S.Z.), and Neurology (S.d.L., D.E.N.-T., D.S.Z.), and Division of Neuro-Visual & Vestibular Disorders (D.E.N.-T.), Johns Hopkins University, Baltimore, MD.

Objective: To explain (1) why an initial upbeat nystagmus (UBN) converts to a permanent downbeat nystagmus (DBN) in Wernicke encephalopathy (WE) and (2) why convergence and certain vestibular provocative maneuvers may transiently switch UBN to DBN.

Methods: Following a literature review and study of our 2 patients, we develop hypotheses for the unusual patterns of vertical nystagmus in WE.

Results: Our overarching hypothesis is that there is a selective vulnerability and a selective recovery from thiamine deficiency of neurons within brainstem gaze-holding networks. Read More

Lakartidningen 2017 09 12;114. Epub 2017 Sep 12.

Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden.

J Basic Clin Physiol Pharmacol 2018 Oct 2;30(2):153-162. Epub 2018 Oct 2.

Clinical Research Unit, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.

Wernicke encephalopathy (WE) and Korsakoff psychosis (KP), together termed Wernicke-Korsakoff syndrome (WKS), are distinct yet overlapping neuropsychiatric disorders associated with thiamine deficiency. Thiamine pyrophosphate, the biologically active form of thiamine, is essential for multiple biochemical pathways involved in carbohydrate utilization. Both genetic susceptibilities and acquired deficiencies as a result of alcoholic and non-alcoholic factors are associated with thiamine deficiency or its impaired utilization. Read More

Cureus 2018 Jul 17;10(7):e2991. Epub 2018 Jul 17.

Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK.

Wernicke's encephalopathy (WE) is a life-threatening acute or sub-acute neurological emergency characterized by ataxia, confusion, nystagmus, and ophthalmoparesis caused by thiamine deficiency. It was first described in 1881 by Carl Wernicke with alcohol being the most common cause. We present a rare case of a 35-year-old pregnant female who presented to our emergency department with a history of vomiting and loose motions for two weeks. Read More

Palliat Support Care 2018 Aug 31:1-2. Epub 2018 Aug 31.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Aichi,Japan.

Objective: Although thiamine deficiency (TD) and Wernicke encephalopathy (WE) are not rare in cancer patients, the cases reported to date developed TD and/or WE after treatment had started.

Method: From a series of cancer patients, we report a patient diagnosed with TD without the typical clinical symptoms of WE at the preoperative psychiatric examination.ResultA 43-year-old woman with ovarian cancer was referred by her oncologist to the psycho-oncology outpatient clinic for preoperative psychiatric evaluation. Read More

Pediatr Int 2018 Aug;60(8):757-758

Department of Pediatric Hematology/Oncology, Okayama University Hospital, Okayama, Japan.

BMJ Case Rep 2018 Aug 20;2018. Epub 2018 Aug 20.

Department of Neurology, Smt BK Shah Medical Institute and Research Centre, Vadodara, Gujarat, India.

Progressive supranuclear palsy (PSP) may be a risk factor for thiamine deficiency. The classic symptoms of PSP (postural instability, supranuclear vertical gaze palsy and dementia) overlap with the clinical triad of Wernicke's encephalopathy (cognitive impairment, gait problems and ocular abnormality). Therefore, superimposed thiamine deficiency in patients with PSP may aggravate the pre-existing symptoms of PSP. Read More

Am J Med 2018 Nov 11;131(11):1321-1323. Epub 2018 Aug 11.

Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee. Electronic address:

Nutr Neurosci 2018 Aug 9:1-3. Epub 2018 Aug 9.

b Department of Psychiatry & Behavioral Sciences, Faculty of Medicine , University of Crete , Voutes, Heraklion 71410 , Greece.

Background: Wernicke encephalopathy (WE) predominantly occurs in alcoholic patients. Few case reports have described this diagnosis as a result of dieting. The diagnosis is often missed or delayed resulting in permanent and severe neurologic sequelae and even death. Read More

Palliat Support Care 2018 Aug 3:1-3. Epub 2018 Aug 3.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Aichi,Japan.

Objective: Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. It is recognized in various stages of the cancer trajectory but has not previously been recognized during nivolumab treatment.

Method: From a series of WE patients with cancer, we report a lung cancer patient who developed WE during treatment with nivolumab. Read More

Cureus 2018 May 9;10(5):e2597. Epub 2018 May 9.

Department of Neurology, University of Missouri, Columbia, USA.

Wernicke's encephalopathy (WE) is a rare neurological syndrome that presents in the setting of thiamine deficiency. Though alcoholism is the most common cause of this condition, a few other etiologies include malnutrition from other causes, hemodialysis, and hyperemesis gravidarum. In this case report, we aim to report a case of a young woman who developed WE in the setting of hyperemesis gravidarum (HG) that improved with thiamine replacement. Read More

Int J Rehabil Res 2018 Dec;41(4):373-376

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey.

Wernicke-Korsakoff syndrome is a type of brain disorder caused by the lack of thiamine, most commonly because of chronic alcohol misuse. It consists of two separate conditions including Wernicke's encephalopathy and Korsakoff syndrome. Various levels of cognitive impairments are associated with the severity of the syndrome. Read More

Psychiatry Clin Neurosci 2018 Oct 31;72(10):774-779. Epub 2018 Jul 31.

Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.

Anorexia nervosa (AN) is a common eating disorder that affects 2.9 million people worldwide. Not eating a balanced diet or fasting can cause neurological complications after severe vitamin B1 malnourishment, although the precise signs and symptoms of Wernicke's encephalopathy (WE) are not clear. Read More

BMJ Case Rep 2018 Jul 6;2018. Epub 2018 Jul 6.

Neurology, Smt B K Shah Medical Institute and Research Centre, Vadodara, Gujarat, India.

Gastrointestinal symptoms, such as anorexia, nausea, vomiting and abdominal pain, are very common in patients with Wernicke's encephalopathy (WE). Mild thiamine deficiency may have only gastrointestinal symptoms. We are reporting two patients with thiamine deficiency who predominantly had gastrointestinal symptoms. Read More

Zhongguo Shi Yan Xue Ye Xue Za Zhi 2018 Jun;26(3):880-885

Department of Hematology, Aerospace Center Hospital, Beijing 100049, China.

Objective: To make through introduction of Wernicke's encephalopathy (WE) following hematopoietic stem cell transplantation (HSCT) in terms of clinical characteristics, diagnostic process and treatment.

Methods: The clinical charactaristics, diagnostic and therapeutic process and prognostic follow-up in 4 patients diagnosed of WE following HSCT between January 2016 to January 2017 at Department of Hematology, Chinese Aerospace Center Hospital were retrospectively analyzed.

Results: Four patients included 2 ALL and 2 AML, and 3 males and 1 female, their age ranged from 8 to 20 years old. Read More

Front Psychiatry 2018 31;9:204. Epub 2018 May 31.

Department of Psychiatry, University of Turku, Turku, Finland.

Non-alcoholic Wernicke's encephalopathy and Korsakoff syndrome are greatly underdiagnosed. There are very few reported cases of neuropsychologically documented non-alcoholic Korsakoff syndrome, and diffusion tensor imaging (DTI) data are scarce. We report clinical characteristics and neuropsychological as well as radiological findings from three psychiatric patients (one woman and two men) with a history of probable undiagnosed non-alcoholic Wernicke's encephalopathy and subsequent chronic memory problems. Read More

Handb Clin Neurol 2018 ;155:333-352

Neurology Service, Hôpital Erasme, Brussels, Belgium.

The cerebellum is a brain region which is particularly susceptible to intoxication. Clinical presentation is heterogeneous. It is often considered that elderly patients and patients presenting pre-existing structural lesions of the posterior fossa are particularly at risk of developing a toxic-induced cerebellar syndrome (TOICS). Read More

Handb Clin Neurol 2018 ;155:117-127

Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, United States. Electronic address:

The nervous system is vulnerable to intrinsic and extrinsic metabolic perturbations. In particular, the cerebellum, with its large Purkinje cells and its high density of neurons and glial cells, has high metabolic demand and is highly vulnerable to metabolic derangements. As a result, many disorders of intermediary metabolism will preferentially and sometimes selectively target the cerebellum. Read More

Oxf Med Case Reports 2018 May 22;2018(5):omy013. Epub 2018 May 22.

Department of Medicine, Changi General Hospital, Singapore.

A 61-year-old gentleman, with a long-standing history of alcohol abuse presented with altered sensorium and unsteady gait for 2 weeks. A diagnosis of Wernicke encephalopathy (WE) was considered. The magnetic resonance imaging brain showed features consistent with the WE, thus supporting the diagnosis. Read More

Surg Obes Relat Dis 2018 07 26;14(7):943-950. Epub 2018 Mar 26.

Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Background: As the vertical sleeve gastrectomy (VSG) becomes increasingly popular, its effect on postoperative micronutrient levels, such as thiamine, becomes more important. We previously found a 1.8% prevalence of thiamine deficiency in bariatric patients before surgery. Read More

Psychosomatics 2018 Jul - Aug;59(4):311-317. Epub 2018 Mar 27.

Durham VA Medical Center, Durham, NC.

Background: Wernicke's encephalopathy is a condition whose treatment many consultation-liaison psychiatrists know quite well. Less clear, however, is the treatment of its dementia disorder descendent, the Korsakoff's syndrome (KS).

Objective: This article seeks to review treatment options and provide recommendations for consultation-liaison psychiatrists treating cognitive impairment in KS. Read More

Palliat Support Care 2018 12 11;16(6):800-802. Epub 2018 May 11.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Nagoya,Japan.

Objective: Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency, and is sometimes overlooked because of the diversity of clinical symptoms.

Method: From a series of WE patients with cancer, we report a lung cancer patient who developed WE, the main symptom of which was agitation.ResultA 50-year-old woman with lung cancer was referred to our psycho-oncology clinic because of agitation lasting for three days. Read More

Front Neurol 2018 24;9:264. Epub 2018 Apr 24.

Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Bilateral vestibulopathy (BVP), which is due to peripheral lesions, may selectively involve certain semicircular canal (SCC). Recent eye movement recordings with search coil and video head impulse test (HIT) have provided insight in central lesions that can cause bilateral and selective SCC deficit mimicking BVP. Since neurological signs or ocular motor deficits maybe subtle or absent, it is critical to recognize central lesions correctly since there is prognostic and treatment implication. Read More