Guidelines
Guidelines Summary
The diagnostic sensitivity for the diagnosis of WE is optimized utilizing the Caine criteria. Sensitivity of the Caine criteria approaches 100% in patients with alcoholism without hepatic encephalopathy. The Caine criteria state that a diagnosis of WE should be considered in any patient with two of the following: nutritional deficiency, altered mental state or memory, oculomotor abnormalities, cerebellar dysfunction. [4]
After bariatric surgery it is recommended to follow up on thiamine status for at least 6 months. [1]
EFNS Guidelines
The European Federation of Neurologic Societies (EFNS) guidelines for WE recommend the following: [1]
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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.
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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).
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Total thiamine in blood sample should be measured immediately before its administration.
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MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B).
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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).
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The overall safety of thiamine is very good (Level B).
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After bariatric surgery we recommend follow-up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation.
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Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room.
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Patients dying from symptoms suggesting WE should have an autopsy.
Media Gallery
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This MRI shows typical high signal intensities (SIs) in the medial thalamus (A), periaqueductal gray (B), mamillary bodies (C), cerebellar vermis (B, C, D), and paravermian superior cerebellum (D). All the lesions represent high SIs on the DWI (E–H). The ADC images of the cerebellar vermis (K, L) and paravermian superior cerebellum (L) show low SIs (arrowheads), whereas other described areas (I, J) show iso-SIs (arrows). Image courtesy of Neurology. Apr 8 2008;70(15):e48.
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