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Symptoms of Wernicke’s encephalopathy

The symptoms of Wernicke’s encephalopathy include mental confusion, paralysis of the nerves that move the eyes (i.e., oculomotor disturbances), and an impaired ability to coordinate movements, particularly of the lower extremities (i.e., ataxia). For example, patients with Wernicke’s encephalopathy may be too confused to find their way out of a room or may not even be able to walk. Many Wernicke’s encephalopathy patients, however, do not exhibit all three of these signs and symptoms, and clinicians working with alcoholics must be aware that Wernicke’s encephalopathy may be present even if the patient presents with only one or two of them. In fact, neuropathological studies after death indicate that many cases of thiamine deficiency–related encephalopathy may not be diagnosed in life because not all the “classic” signs and symptoms are present or recognized.

Approximately 80 to 90 percent of alcoholics with Wernicke’s encephalopathy develop Korsakoff’s psychosis, a chronic neuropsychiatric syndrome characterized by behavioral abnormalities and memory impairments. Although these patients have problems remembering old information (i.e., retrograde amnesia), it is the disturbance in acquisition of new information (i.e., anterograde amnesia) that is most striking. For example, these patients can engage in a detailed discussion of events in their lives but cannot remember ever having had that conversation an hour later. Because of these characteristic memory deficits, Korsakoff’s psychosis also is called alcohol amnestic disorder. It is still somewhat controversial, however, whether Korsakoff’s psychosis always is preceded by Wernicke’s encephalopathy or whether it develops in fits and starts, without an overt episode of Wernicke’s encephalopathy.