{"id":2771,"date":"2010-02-14T18:00:20","date_gmt":"2010-02-14T23:00:20","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=2771"},"modified":"2013-08-16T00:05:09","modified_gmt":"2013-08-16T04:05:09","slug":"wernickes-syndrome","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2010\/02\/wernickes-syndrome\/","title":{"rendered":"Wernicke’s Syndrome"},"content":{"rendered":"

Pathophysiology<\/strong><\/p>\n

1)<\/strong> caused by thiamine deficiency (vitamin B1) 2)<\/strong> usually (but not always) seen in chronic alcoholism<\/p>\n

Signs and Symptoms<\/strong><\/p>\n

1)<\/strong> progressive ataxia 2)<\/strong> polyneuropathy 3)<\/strong> impaired ocular motility\/nystagmus\/lateral rectus palsy 4)<\/strong> mental confusion 5)<\/strong> tachycardia 6)<\/strong> hypotension 7)<\/strong> Charcot’s triad – ophthalmoplegia, ataxia, confusion<\/p>\n

Characteristic Test Findings<\/strong><\/p>\n

Laboratory<\/em> – 1) decreased serum thiamine 2) abnormal erythrocyte transketolase activity<\/p>\n

Histology\/Gross Pathology<\/strong><\/p>\n

1)<\/strong> petechiae in mamillary bodies, hypothalamus, and periaqueductal gray matter 2)<\/strong> necrosis of nerve cells 3)<\/strong> “ring” hemorrhages in brain<\/p>\n

Associated Conditions<\/strong><\/p>\n

1)<\/strong> occurs in patients with – chronic alcoholism, hyperemesis, starvation, renaly dialysis, cancer, HIV 2)<\/strong> increased incidence of – cardiomyopathy, high-output cardiac failure<\/p>\n

Treatment<\/strong><\/p>\n

1)<\/strong> considered a medical emergency, and thiamine must be given in first few days of symptoms before condition becomes irreversible 2)<\/strong> parenteral thiamine (50mg) for the first several days and then by mouth until symptoms resolve<\/p>\n

Biochemistry<\/strong><\/p>\n

glutamate accumulates in the brauin owing to malfunctioning alpha ketoglutarate dehydrogenase activity<\/p>\n

Inheritance\/Epidemiology<\/strong><\/p>\n

may be a genetic predisposition owing to a variant type of transketolase (thiamine is a cofactor for this enzyme)<\/p>\n

Tips for USMLE<\/strong><\/p>\n

1)<\/strong> Wernicke’s syndrome and Wernicke-Korsakoff syndrome are different clinical syndromes 2)<\/strong> Wernicke-Korsakoff (or Korsakoff psychosis) is impaired memory (often with confabulation) seen in chronic alcoholism, neuronal loss in the medial-dorsal nucleus 3)<\/strong> glucose given before thiamine can unmask subclinical Wernicke’s so thiamine is always given to chronic alcoholics before IV containing glucose 4)<\/strong> there are two different Charcot’s triads – ophthalmoplegia, ataxia, and mental confusion in Wernicke’s and pain, fever, and jaundice in cholangitis<\/p>\n","protected":false},"excerpt":{"rendered":"

Pathophysiology 1) caused by thiamine deficiency (vitamin B1) 2) usually (but not always) seen in chronic alcoholism Signs and Symptoms 1) progressive ataxia 2) polyneuropathy 3) impaired ocular motility\/nystagmus\/lateral rectus palsy 4) mental confusion 5) tachycardia 6) hypotension 7) Charcot’s triad – ophthalmoplegia, ataxia, confusion Characteristic Test Findings Laboratory – 1) decreased serum thiamine 2) […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5103,63],"tags":[446,1308,1310,1307,1309],"yoast_head":"\nWernicke's Syndrome - 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