Some patient can present with hyperactive delirium secondary to possible alcohol withdrawal symptoms alongside Wernicke encephalopathy. Disorientation and altered sensorium characterize encephalopathy. Physical examination may include a complete neurological exam with cerebellar testing. Also, gait can worsen, and in many cases, patients are unable to walk. Gait ataxia is also a significant finding in Wernicke encephalopathy where patients will present with a broad-based gait. Other oculomotor symptoms include cranial nerve involvement of oculomotor, abducens, and vestibular nuclei causing conjugate gaze palsies. The hallmark sign of Wernicke encephalopathy is ocular abnormalities especially nystagmus. The diagnosis is made based on clinical presentation, and a definitive diagnosis is complicated as the clinical triad may not be present in up to 90% of patients. ![]() The classic triad of Wernicke encephalopathy is altered mental status, ataxic gait, and ophthalmoplegia. ![]() Wernicke encephalopathy should be suspected in any patient with chronic alcohol abuse or any form of malnutrition and any of the following: acute altered mental status, ophthalmoplegia, ataxic gait, delirium, and hypotension. Confabulations can be spontaneous or provoked with provoked confabulation commonly seen in chronic Korsakoff syndrome and spontaneous confabulation usually noted in the acute Wernicke state. The disorder is associated with patients fabricating stories in the setting of clear consciousness. Immediate memory is maintained, but short-term memory is diminished with intact sensorium. Korsakoff syndrome is a neuropsychiatric disorder associated with memory disturbances in which there are significant deficits in anterograde and retrograde memory. ![]() This should be differentiated from Korsakoff syndrome which is preventable and is usually suspected as a consequence of at least one episode of Wernicke’s encephalopathy. This is a life-threatening illness caused by thiamine deficiency, which primarily affects the peripheral and central nervous systems. Wernicke encephalopathy (WE) is an acute neurological condition characterized by a clinical triad of ophthalmoparesis with nystagmus, ataxia, and confusion.
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