What is Wernicke encephalopathy?

Wernicke (or Wernicke's) encephalopathy is a type of brain injury that mostly happens to people who drink a lot of alcohol. It is a medical emergency. If not treated quickly, it can lead to permanent brain damage.

Wernicke encephalopathy can lead to a condition called Wernicke-Korsakoff syndrome. This is sometimes known as 'alcohol-related dementia' because it causes symptoms that are similar to dementia.

Seek urgent medical attention if you or someone you know seems confused, cannot move their eyes properly, or cannot coordinate their movements properly — especially if they are a heavy drinker or are withdrawing from alcohol.

What are the symptoms of Wernicke encephalopathy?

The symptoms of Wernicke encephalopathy usually come on quite quickly. Symptoms can vary, but often include:

• problems with the eyes, such as jerky movement, double vision or drooping eyelids
• problems with balance, such as when trying to stand
• problems with movement, such as difficulty walking normally
• problems with the mind, such as feeling disoriented, drowsy or confused
• symptoms of alcohol withdrawal

Other less common symptoms include:

• weakness of the arms and legs
• rapid heartbeat
• low blood pressure on standing (known as postural hypotension)

Many people with Wernicke syndrome go on to develop symptoms of Korsakoff syndrome, such as severe short-term memory loss, and trouble forming new memories and learning new things.

If you think that you, or someone you know, may have Wernicke encephalopathy, it is very important to get medical help straight away.

What are the causes of Wernicke encephalopathy?

Wernicke encephalopathy is caused by a person not getting enough of a nutrient called thiamine, a type of vitamin B.

People who drink too much alcohol often do not get enough thiamine, partly because they tend to have a poor diet, and partly because alcohol irritates the lining of the stomach and makes it harder to absorb certain vitamins.

People can also be at risk of thiamine deficiency if they are receiving chemotherapy, or if they have AIDS, an eating disorder, or some other condition that makes it hard for them to eat well such as bariatric surgery.

When should I see my doctor?

If you have any signs of Wernicke encephalopathy, you need to seek medical help straight away. If you don't, you run the risk of permanent brain damage.

If you have problems with alcohol, seek help before you get a condition like Wernicke encephalopathy. Talk to your doctor, or get help from an organisation such as Alcoholics Anonymous.

If you are concerned about whether you are getting enough thiamine in your diet, talk to your doctor or see a dietician.

How is Wernicke encephalopathy diagnosed?

People with Wernicke encephalopathy do not always display the same symptoms, so it can be hard to diagnose the condition correctly. Sometimes, it can be mistaken for other problems that cause confusion, such as alcohol withdrawal or severe liver disease.

To diagnose Wernicke encephalopathy, a doctor will usually:

• ask about your medical history and symptoms
• examine you physically
• run some tests, such as blood and urine tests
• refer you for some imaging tests, such as a CT scan or an MRI scan

How is Wernicke encephalopathy treated?

If you have Wernicke encephalopathy, you will need to be treated with thiamine as quickly as possible. This is given through injection into the vein. Treatment also involves getting proper nutrition and hydration (enough water in the body). In some cases, medications might also be used.

If you are treated in time, most symptoms can be reversed, although it can take a while for some symptoms to go away. If you are not treated in time, you could end up with permanent brain damage.

Longer term, someone with Wernicke encephalopathy may need support to manage problems with their nutrition or alcohol intake.

Resources and support

• National Organization for Rare Disorders (US) - for detailed information about Wernicke-Korsakoff syndrome
• Alcoholics Anonymous - for people who have problems with alcohol
• Arbias - for people with alcohol or drug-related brain injury
• Dementia Australia - for people affected by the symptoms of dementia