special subjects
Wernicke Encephalopathy
Symptoms and Signs of Wernicke Encephalopathy
In patients with Wernicke encephalopathy, clinical changes occur suddenly. , including horizontal and vertical nystagmus and partial ophthalmoplegias (eg, lateral rectus palsy, Conjugate Gaze Palsies ), are common. Pupils may be abnormal; they are usually sluggish or unequal. Vestibular dysfunction without hearing loss is common, and the oculovestibular reflex may be impaired. Gait ataxia may result from vestibular disturbances, cerebellar dysfunction, and/or polyneuropathy; gait is wide-based and slow, with short-spaced steps. Global confusion is often present; it is characterized by profound disorientation, indifference, inattention, drowsiness, or stupor. Peripheral nerve pain thresholds are often elevated, and many patients develop severe autonomic dysfunction characterized by sympathetic hyperactivity (eg, tremor, agitation) or hypoactivity (eg, hypothermia, postural hypotension, syncope). In untreated patients, stupor may progress to coma, then to death. 