You are here: Home / IBCC / Wernicke encephalopathy ... Note: abnormalities in the corpus callosum should raise concern for ... One small study found that in a population of patients with alcoholism, 250 mg thiamine IM daily ...Youarehere:Home/IBCC/WernickeencephalopathyCONTENTSPathophysiologySigns&SymptomsRiskfactorsEpidemiologyLaboratorystudiesImagingDifferentialdiagnosis&securingthediagnosisPreventionTreatmentPrognosisSummaryPodcastQuestions&discussionPitfallsPDFofthischapter (or createcustomizedPDF)pathophysiology(backtocontents)biochemistryThiamineisaco-factorinnumerousenzymaticreactionsinvolvedinenergymetabolism,asshownbelow.  Thiaminedeficiencyhasconsequencesincludingthefollowing:(1) Accumulationoflactate(2)Excessproductionofglutamate,whichmayleadtoexcessiveexcitatoryneurotransmissioninthebrainThiscancausevasogenicandcytotoxicedema.pharmacologyofthiamineThedailyrequirementofthiamineis~1-2mg. Thiamineisabsorbedinthejejunumandstoredintheliver. Absorptionisrelativelyinefficient;forexample,onestudyofhealthyvolunteersfoundthatonly5%ofa50-mgoraldosewasabsorbed.(30146080)  However,arecentstudysuggeststhatthismightbeovercomewiththeuseofveryhighdosesoforalthiamine,asshowninthefigurebelow.(22305197)Totalbodystoresofthiamineare~30mg(butpotentiallylowerinliverdisease).Inadequatethiamineintakecancauseapreviouslyhealthypersontobecomedeficientwithin~2-4weeks.(32551830) Inthecontextofacuteorchronicillness,deficiencycanoccurmorerapidly.  signs&symptoms(backtocontents)Signsandsymptomsaregenerallyunreliableinthediagnosis.Theclassictriadofencephalopathy,ophthalmoplegia,andataxiaispresentinonly~15%ofcases. Amongnon-alcoholicpatientswithWernickeencephalopathy,thetriadisevenlesscommon.(31171116) #1=encephalopathyDeliriumisthemostconsistentclinicalcharacteristic.Thismayprogresstocoma.IsolatedencephalopathywithoutocularorcerebellarsignsmaybemorecommoninnonalcoholicWernickeencephalopathy.(32390125)#2=ophthalmoplegiasHorizontalnystagmusisthemostcommonfinding(althoughbothhorizontalandve