Wernicke Encephalopathy Guidelines

Updated: Nov 20, 2018
  • Author: Philip N Salen, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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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]

  • 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.
  • 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).
  • Total thiamine in blood sample should be measured immediately before its administration.
  • MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B).
  • 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).
  • The overall safety of thiamine is very good (Level B).
  • After bariatric surgery we recommend follow-up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation.
  • Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room.
  • Patients dying from symptoms suggesting WE should have an autopsy.