Wernicke Encephalopathy

It is the sudden damage and inflammation of the brain as a result of a severe deficiency of vitamin B1 (Thiamine), which is essential for the brain to function healthily and produce energy.

Chronic alcohol consumption is the biggest cause (alcohol reduces the absorption of vitamin B1 to zero and excretes it from the body). However, it is not only seen in alcoholics. Prolonged malnutrition experienced after severe vomiting during pregnancy (Hyperemesis), anorexia, hunger strikes, or obesity (sleeve gastrectomy) surgeries also lead to this disease.

There is a triad that diagnoses the disease:
1. Confusion: The patient does not know where they are, is indifferent, and experiences memory loss.
2. Eye Muscle Paralysis (Ophthalmoplegia): The eyes cannot move left and right, there is double vision and eye twitching (nystagmus).
3. Ataxia: Balance is completely lost, the patient walks like they are drunk or cannot walk at all.

The Wernicke presentation is an acute crisis. If it is not treated within the first 24-48 hours, the damage in the brain becomes irreversible and Korsakoff Syndrome (Wernicke-Korsakoff) begins. In this stage, the patient cannot learn anything new (severe amnesia) and fills in the gaps they cannot remember by 'making up stories' (confabulation).

Looking for a B1 (Thiamine) deficiency in blood tests wastes time. The diagnosis is made entirely based on the patient's history (alcohol/eating disorder) and clinical findings in the emergency room or by a Neurologist; Contrast-enhanced Brain MRI supports the diagnosis.

It is a medical emergency racing against time, where seconds are important! The treatment is to immediately give the patient high-dose Vitamin B1 (Thiamine) via IV or intramuscular injection. Hours after the medication is given, the patient's eye movements and confusion improve at a dramatic speed.