Non-alcoholic Wernicke's encephalopathy in a thiamine-deficient population: A clinical and diagnostic perspective

Abstract

Background

Wernicke's encephalopathy (WE) is a neurological disorder classically associated with alcohol use, but increasingly recognized in non-alcoholics due to nutritional deficiencies, especially among vulnerable groups such as pregnant and postpartum women. The clinical diagnosis of Wernicke's encephalopathy is often challenging, as the classical triad of symptoms–encephalopathy, ophthalmoplegia and ataxia–frequently presents incompletely or may be entirely absent.

Aims

WE, although commonly associated with alcoholism, is frequently underdiagnosed in the non-alcoholic population and a delayed diagnosis can result in poor clinical outcomes. This study focuses on cases of non-alcoholic WE, aiming to evaluate the clinical and biochemical presentation in these patients.

Methods

This prospective study was conducted in patients presenting with acute confusional states who demonstrated clinical improvement following thiamine administration. Baseline clinical, biochemical and radiological parameters were recorded for all participants. A standardized questionnaire was administered and informed consent was obtained from all patients prior to inclusion in the study.

Summary

A total of 18 patients were enrolled in the study. The patients presented with ataxia (100.0%), confusion (100.0%) and acute onset encephalopathy (63.2%). The MRI showed symmetrical hyperintensity in T2 and FLAIR involving mammillary bodies (38.8%), only periaqueductal grey matter (50.0%), thalami (44.4%) and periventricular third ventricle (38.8%). Nearly 33.0% of patients had signal alteration in all regions including the thalamus, hypothalamus and periaqueductal area and atrophy of mammillary bodies. Non-alcoholic WE is potentially reversible and treatment should be promptly initiated in patients, particularly in high-risk populations.