EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy


Dr. M. Leone, Clinica Neurologica, Ospedale Maggiore della Carità, C. Mazzini 18 – 28100 Novara, Italy (tel.: +39 0321/3733218; fax: +39 0321/3733298; e-mail: maurizio.leone@maggioreosp.novara.it).


Background:  Although Wernicke encephalopathy (WE) is a preventable and treatable disease it still often remains undiagnosed during life.

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

Methods:  We searched MEDLINE, EMBASE, LILACS, Cochrane Library.

Conclusions and recommendations:   

  • 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 (good practice point – GPP).
  • 2 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).
  • 3 Total thiamine in blood sample should be measured immediately before its administration (GPP).
  • 4 MRI should be used to support the diagnosis of acute WE both 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 thrice 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 (GPP).
  • 8 Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room (GPP).
  • 9 Patients dying from symptoms suggesting WE should have an autopsy (GPP).