Wernicke encephalopathy in nonalcoholic patients

Background. Wernicke encephalopathy is associated with patients that have a history of alcohol abuse and other malnourished states. However, clinicians may be less likely to recognize this condition in nonalcoholic patients. This study was undertaken to evaluate the cause, diagnosis, treatment, and outcome of nonalcoholic patients with Wernicke encephalopathy. Methods: A retrospective review was conducted of all cases of Wernicke disease from 1984 to 1999 evaluated at a rural university hospital. Inclusion criteria consisted of patients diagnosed clinically with this disorder who improved after the administration of thiamin. Patients were also included in the series if they had classic pathologic findings of the disease on autopsy even without a prior clinical diagnosis. Results: Twelve patients were identified. Alcohol abuse was noted in only 50%. The patients without a history of alcohol abuse had other malnourished states, such as end-stage cancer, intractable vomiting after gastric reduction procedure, and prolonged hospital courses on intravenous fluids without other sources of nutrition. The mortality rate was 4 of 12 (33%) but due to multiple causes. Autopsies were performed on all 4 patients. Three of these 4 patients had no history of alcohol abuse. Two of the nonalcoholic patients were not diagnosed until autopsy, whereas all the patients with a history of alcohol abuse were diagnosed clinically. Discussion: Our study reveals that Wernicke encephalopathy continues to be a rare but life-threatening condition often overlooked in the nonalcoholic population, resulting in the further progression of an easily treatable condition.