17. Diagnosis, Therapy and Prevention of Wernicke's Encephalopathy

  1. Nils Erik Gilhus MD, PHD7,8,
  2. Michael P. Barnes MD, FRCP9,10 and
  3. Michael Brainin MD11,12,13
  1. R. Galvin1,
  2. G. Brathen2,
  3. A. Ivashynka3,
  4. M. Hillbom4,
  5. R. Tanasescu5 and
  6. M. A. Leone6

Published Online: 21 SEP 2011

DOI: 10.1002/9781444346268.ch17

European Handbook of Neurological Management, Volume 2, Second Edition

European Handbook of Neurological Management, Volume 2, Second Edition

How to Cite

Galvin, R., Brathen, G., Ivashynka, A., Hillbom, M., Tanasescu, R. and Leone, M. A. (2011) Diagnosis, Therapy and Prevention of Wernicke's Encephalopathy, in European Handbook of Neurological Management, Volume 2, Second Edition (eds N. E. Gilhus, M. P. Barnes and M. Brainin), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346268.ch17

Editor Information

  1. 7

    Department of Clinical Medicine, University of Bergen, Norway

  2. 8

    Department of Neurology, Haukeland University Hospital, Bergen, Norway

  3. 9

    University of Newcastle, Newcastle upon Tyne, UK

  4. 10

    Hunters Moor Neurorehabilitation Ltd, Newcastle upon Tyne, UK

  5. 11

    Department of Clinical Medicine and Prevention, Austria

  6. 12

    Center for Clinical Neurosciences, Donau-Universität Krems, Austria

  7. 13

    Department of Neurology, Landesklinikum Donauregion Tulln, Tulln, Austria

Author Information

  1. 1

    Cork University Hospital, Wilton, Cork, Ireland

  2. 2

    Trondheim University Hospital, Trondheim, Norway

  3. 3

    National Neurology and Neurosurgery Research Centre, Minsk, Belarus

  4. 4

    Oulu University Hospital, Oulu, Finland

  5. 5

    Colentina Hospital, University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania

  6. 6

    Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, Italy

Publication History

  1. Published Online: 21 SEP 2011
  2. Published Print: 30 SEP 2011

ISBN Information

Print ISBN: 9781405185349

Online ISBN: 9781444346268



  • diagnosis, therapy and prevention-of Wernicke's encephalopathy;
  • Wernicke's encephalopathy (WE)-acute or subacute neurological disorder, thiamine(vitamin B1) deficiency;
  • disease, rare, catastrophic in onset-clinically complex and delayed in diagnosis;
  • revised European Federation of Neurological Societies (EFNS) scientific task force guidance;
  • WE diagnosed in life, and how often-frequently undiagnosed during life;
  • clinical features of alcohol-dependent WE-different from non-alcohol-dependent WE;
  • erythrocyte transketolase activity assay-thiamine pyrophosphate effect;
  • computed tomography (CT)-not a reliable test for WE;
  • prophylactic thiamine therapy-and its place in WE;
  • thiamine supplementation-into food, preventing development of WE (GPP)


Backround: Although Wernicke encephalopathy (WE) is a preventable and treatable disease it often remains undiagnosed.

Objectives: To create practical guidelines for diagnosis, management and prevention of the disease.

Methods: we searched Medline, EMBASE, LILACS and the Cochrane Library.

Recommendations: (1) The clinical diagnosis of WE should take into account the different presentations of clinical signs between alcoholics and non-alcoholics (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). (2) The clinical diagnosis of WE in alcoholics requires two of the following four signs: (a) dietary deficiencies, (b) eye signs, (c) cerebellar dysfunction, and (d) either an altered mental state or mild memory impairment (Level B). (3) Total thiamine in a blood sample should be measured immediately before its administration (good practice point). (4) MRI should be used to support the diagnosis of acute WE 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 three times 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 (good practice point). (8) Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room (good practice point). (9) Patients dying from symptoms suggesting WE should have an autopsy (good practice point).