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Wernicke’s Encephalopathy in the Absence of Alcohol Use

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Abstract

Purpose of Review

This review summarizes the clinical manifestations, diagnosis, and treatment of Wernicke’s encephalopathy (WE) in the absence of alcohol use. Emergency physicians are well-acquainted with the disorder when associated with alcohol, but this reversible disease should be considered as part of the differential in numerous other patient populations.

Recent Findings

Treatment for WE has not changed significantly, and standard of care continues to be high-dose thiamine, although dosing and duration vary between different society guidelines. Radiographic evidence of disease continues to evolve. More recent literature focuses on at-risk groups more so than advances in treatment and includes numerous case reports of patients with non-alcoholic WE with etiologies such as gastric surgery, cancer, and HIV/AIDS.

Summary

Timely identification of WE in the emergency department leads to more rapid treatment with high-dose thiamine and reduced morbidity. Because there is evidence that WE may be under-diagnosed and treatment is both low risk and cost-effective, wider consideration of at-risk individuals and more research into treatment specifically among those with non-alcoholic WE are warranted.

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Acknowledgements

The authors wish to thank Dr. Daniel Hrabec for reviewing their manuscript and Dr. Courtney Cave for reviewing their MRI images

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Authors and Affiliations

  1. Department of Emergency Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Katherine M. Joyce, Thayer Morton, Thomas Hagerman, Daniel Cotton, Naureen Farook & Joseph Miller

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  1. Katherine M. Joyce
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Contributions

KJ, TM, TH, DC and NF wrote the main manuscript text.  KJ developed the case study and prepared Fig. 1.  TH prepared Table 2. JM provided substantial guidance and editing.  All authors reviewed the manuscript.

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Correspondence to Katherine M. Joyce.

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Joyce, K.M., Morton, T., Hagerman, T. et al. Wernicke’s Encephalopathy in the Absence of Alcohol Use. Curr Emerg Hosp Med Rep 11, 189–197 (2023). https://doi.org/10.1007/s40138-023-00278-z

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