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EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy
Article first published online: 19 JUL 2010
© 2010 The Author(s). European Journal of Neurology © 2010 EFNS
European Journal of Neurology
Volume 17, Issue 12, pages 1408–1418, December 2010
How to Cite
Galvin, R., Bråthen, G., Ivashynka, A., Hillbom, M., Tanasescu, R. and Leone, M. A. (2010), EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European Journal of Neurology, 17: 1408–1418. doi: 10.1111/j.1468-1331.2010.03153.x
- Issue published online: 18 NOV 2010
- Article first published online: 19 JUL 2010
- Received 20 April 2010 Accepted 14 June 2010
- Wernicke encephalopathy
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:
- 1The 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).
- 2The 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).
- 3Total thiamine in blood sample should be measured immediately before its administration (GPP).
- 4MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B).
- 5Thiamine 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).
- 6The overall safety of thiamine is very good (Level B).
- 7After bariatric surgery we recommend follow-up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation (GPP).
- 8Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room (GPP).
- 9Patients dying from symptoms suggesting WE should have an autopsy (GPP).