Wernicke encephalopathy is a systemic degenerative brain disease based on vitamin B1 deficiency. Alcoholics, patients with eating disorders or chronic intestinal diseases are particularly often affected by the disease. The treatment is anchored in a substitution of the missing thiamine.
What is Wernicke encephalopathy?
Encephalopathies are injuries that affect the brain as a whole. They can be caused, for example, by degenerative diseases. However, whole brain damage can also be systemic and thus associated with cardiopulmonary, renal, hepatic or endocrine diseases that have metabolic consequences for the brain. For hhs meanings, please visit whicheverhealth.com.
The brain depends on various substances. These substances include vitamin B1, also known as thiamine. Thiamine is particularly needed in certain brain regions because it maintains the activity of the ion channels in axons. In addition to the causes mentioned, an encephalopathy can also be caused by a lack of thiamine.
Encephalopathy caused in this way is referred to as degenerative Wernicke encephalopathy or Wernicke-Korsakov syndrome, which usually affects adults. The first description of the disease goes back to C. Wernicke, who first described the disease in three alcoholics in the 19th century.
The primary cause of Wernicke encephalopathy is hypovitaminosis. This vitamin deficiency can be due to chronic alcohol abuse, for example. Other common associations include eating disorders, bariatric surgery, malnutrition, chronic bowel disease with diarrhea and vomiting, or chemotherapy.
Vitamin B1 deficiency, also known as thiamine deficiency, occurs with hypovitaminosis. Thiamine is essential as a cofactor for the intermediary metabolism, for example for processes such as ketoglutarate dehydrogenase, transketolase or pyruvate dehydrogenase. The intermediary metabolism is thus severely impaired by a vitamin B1 deficiency. The energy metabolism is damaged and cells perish.
Due to cell death, Wernicke encephalopathy is to be understood as a neurodegenerative disease and primarily affects areas of the brain with a high thiamine requirement. There is a particularly high demand in the corpora mamillaria, but the area around the third cerebral ventricle, the nuclei of the thalamus, the corpora geniculata or the aqueduct area can also be affected.
Symptoms, Ailments & Signs
In the acute course of Wernicke encephalopathy, a reddish-brown discoloration can be seen macroscopically in the regions of the brain that require thiamine. Multiple petechiae hemorrhages can be identified. In the chronic course, atrophy of the mamillary bodies occurs. The histological picture is characterized by ganglion cell loss.
Spongy nerve loosening can occur microscopically, which is characterized by glial and vascular proliferation with siderophages. From a clinical point of view, a classic triad consists of impaired consciousness or disorientation, gait ataxia and disorders of the eye muscles. There is usually a brain-organic psychosyndrome characterized by cognitive disorders. Intellectual decline with memory loss can also be a characteristic symptom.
In addition to eye muscle paresis, nystagmus of the eyes can also be present. Additional symptoms can be polyneuropathies, reflex disorders and dysdiadochokinesis. Dysphagia, dysarthria or vegetative disorders such as hypotension, hypothermia or hyperhidrosis are just as widespread. Which disorders are present in detail depends on the individual case and the affected brain regions. The respective cause can also vary the clinical picture to a greater or lesser extent in individual cases.
Diagnosis & course of disease
The suspected diagnosis of Wernicke syndrome is presented to the doctor with the anamnesis and the first impression of the clinical picture of the patient. In the anamnesis, previously diagnosed intestinal diseases, eating disorders or alcohol problems can be an important clue. To establish a connection with vitamin deficiency, the vitamin B1 level in the blood is detected.
The plasma level can produce false-negative values. Therefore, a more sensitive [[[whole blood test]] becomes the diagnostic of choice. In order to determine the localization of brain lesions in more detail, an imaging procedure is usually used. Both CT and MRI are suitable methods. The course of the disease depends on the primary cause of the vitamin deficiency.
A chronic intestinal disease, for example, usually has a more unfavorable course than a currently acute intestinal disease with only intermittent diarrhea and vomiting. In the case of Wernicke encephalopathy after alcohol abuse or eating disorders, the course depends exclusively on the patient’s cooperation. If left untreated, the disease can be fatal.
Wernicke’s encephalopathy has a very negative effect on the patient’s consciousness and can therefore lead to various serious complaints. As a rule, those affected suffer from impaired consciousness and can no longer cope with their everyday life on their own. There are disturbances in concentration and coordination, so that the patients are usually always dependent on the help of other people.
This also prevents the intake of food and liquids. Memory loss often occurs, and further various cognitive disorders that negatively affect the patient’s quality of life. Most sufferers also lose consciousness falling into a coma.
However, the severity of the symptoms of Wernicke encephalopathy depends heavily on their exact cause, so that no general prediction can be made here. In treatment, however, it is always necessary to treat the underlying disease first. The symptoms of the disease can be limited in some cases.
However, a completely positive course of the disease is not achieved. The patient’s relatives are often also affected by psychological problems and therefore also need psychological treatment.
When should you go to the doctor?
Changes and abnormalities in brain activity should always be examined and clarified by a doctor. If eating disorders, diarrhea or vomiting occur, health check-ups are advisable. Deficiency symptoms, changes in mental or physical performance and disorientation must be examined as soon as possible. In the event of disorders of consciousness or loss of consciousness, an emergency service must be alerted.
There is an acute health-threatening situation that requires intensive medical care. A doctor is required in the event of excessive alcohol consumption, a reduction in physical strength and a persistent or increasing feeling of illness. If the person concerned refuses to eat or is unable to independently stop consuming alcohol, they must seek the help of a doctor as soon as possible.
If speech disorders, states of confusion or an involuntary twitching of the muscles appear, the person concerned needs medical support. Since Wernicke encephalopathy is fatal if left untreated, a doctor’s visit should take place as soon as the first irregularities appear. If the person concerned is no longer able to meet everyday obligations, behavioral problems and changes in personality become apparent, this is considered to be extremely worrying. A doctor is needed to clarify the cause.
Treatment & Therapy
Wernicke encephalopathy is treated with different focuses depending on the primary cause. In the case of alcohol abuse as the primary cause, for example, absolute abstinence from alcohol is the therapy recommendation of choice. The doctor must make the patient aware of the connections between his illness and usually works together with a psychotherapist. A closed or open alcohol therapy is often the only possibility for lasting improvement.
Closed or open therapies are also the treatment of choice for eating disorders. In order to alleviate Wernicke encephalopathy as a symptom of eating disorders or alcohol addiction in an acute phase, high doses of thiamine are administered parenterally. Absorption of oral thiamine is variable and poorly controlled. Therefore, intravenous administration is the more sensible treatment route in emergency situations. Usually about 200 milligrams of thiamine is administered over two days.
However, a three-times-daily dose of 500 milligrams over two days is also an option. After completing these measures, long-term oral administration over a certain period of time is recommended. In addition to drug therapy, magnesium is often administered. People with chronic bowel disease usually require lifelong thiamine supplementation.
For patients with symptoms of malnutrition, ideally an informative nutrition plan is also drawn up. Diet plans can generally be useful in connection with the treatment of Wernicke encephalopathies.
Wernicke encephalopathy can be prevented to a certain extent by eating a balanced diet and drinking alcohol responsibly. As a consequence of various intestinal diseases, the disease cannot always be prevented by these measures.
Follow-up treatment for Wernicke encephalopathy depends on the underlying disease. Since there is a vitamin B-1 deficiency in all cases of Wernicke encephalopathy, another vitamin B-1 deficiency must be avoided. For this purpose, vitamin B-1 should be taken as a precaution in moderate doses as a food supplement in addition to the daily food intake.
In addition, the vitamin B-1 level in the blood must be checked regularly in order to detect a renewed deficiency at an early stage. If a chronic inflammatory bowel disease (Crohn’s disease) has led to the development of the vitamin B1 deficiency, this must be treated permanently and causally. If an alcohol-related illness is responsible for the development of the vitamin B-1 deficiency and the subsequent Wernicke encephalopathy, alcohol withdrawal must take place.
This may require an inpatient stay in a rehab clinic. If chemotherapy has led to the development of the disease, an increased vitamin B-1 intake must take place. Since dietary supplements are often not sufficient for chemotherapy, this can also be done intravenously via infusions.
If the cause of the vitamin B-1 deficiency underlying the disease cannot be clearly identified, various gastroenterological (colonoscopy) and endocrinological examinations (hormone tests) must be carried out in order to be able to identify and treat it. In addition, regular neurological examinations of motor functions, sensory functions, reflexes and coordination as well as imaging of the brain (MRT, CT) should be carried out in order to be able to identify and treat long-term damage to nerves and the brain at an early stage.
You can do that yourself
The possibilities for self-help are very limited in the event of an outbreak of Wernicke encephalopathy. There is a pre-existing condition that needs to be treated and treated. In most cases, it is an addiction or a health disorder with a chronic course. The person concerned should clarify and eliminate the causes of the underlying disease as far as possible. This is only possible with difficulty, since he is usually already in an advanced stage of the disease at hand.
Nevertheless, the consumption of harmful substances should be minimized under all circumstances. If possible, the consumption of alcohol should be avoided completely. Addicts only manage this step on their own in very few cases. It is therefore advisable to work with a doctor and a psychotherapist.
The motivation to change is the basic prerequisite for an improvement in the overall situation. Equally important are enhancing overall well-being and setting life goals to achieve. This procedure supports changes in behavior and contributes significantly to alleviating existing symptoms.
Targeted training and exercise sessions help to improve concentration. These can be implemented independently at any time and help with memory activity. In addition, a healthy and balanced diet is important to support the functioning of the organism.