Guideline sources The following summarized guidelines for the evaluation and management of Wernicke's encephalopathy (WE) are prepared by our editorial team based on guidelines from the European Federation of Neurological Societies (EFNS 2010). 1 Pathway Wernicke's encephalopathy Diagnosis and management Guidelines 1. Screening and diagnosis Population at risk: consider the diagnosis of WE in patients at risk for thiamine deficiency, such as patients with alcohol abuse, bariatric surgery, hyperemesis gravidarum, starvation, gastrointestinal tract disease, AIDS, malnutrition, cancer, dialysis-dependent kidney disease, chronic vomiting, stem cell transplantation, or thyroid disease. E Diagnostic criteria: Diagnose WE in patients with AUD who present with 2 of the following: dietary deficiencies eye signs https://web.pathway.md/diseases/reciIwhkRp6pibxdg 1/3 6/29/23, 3:15 AM Wernicke's encephalopathy Pathway eye signs cerebellar dysfunction altered mental state or mild memory impairment. B Consider using the same criteria to diagnose WE in patients not using alcohol. E 2. Diagnostic investigations Thiamine levels: obtain a blood sample for measurement of total thiamine immediately before administration of thiamine in patients with suspected WE. E Brain magnetic resonance imaging: obtain an MRI of the brain to support the diagnosis of acute WE in patients with and without AUD. B 3. Medical management Thiamine supplementation (patients with suspected or manifest WE): administer intravenous thiamine (200 mg IV q8h) in patients with suspected WE. Initiate thiamine prior to giving any carbohydrates. B Thiamine supplementation (patients at risk): administer IV thiamine in all patients at risk for WE admitted to the emergency room. E 4. Specific circumstances Patients post bariatric surgery: Initiate parenteral thiamine supplementation after bariatric surgery. E Monitor thiamine status for at least 6 months after bariatric surgery. B Patients dying from Wernicke's encephalopathy: request an autopsy in terminally ill patients displaying signs or symptoms of WE. E Clinical findings Symptoms Past medical history Amnesia AUD Confusion Vital signs Hearing loss Memory impairment Hypotension Social history Ocular exam Alcohol consumption Papilledema Neurological exam Imaging findings Altered mental status https://web.pathway.md/diseases/reciIwhkRp6pibxdg 2/3 6/29/23, 3:15 AM Wernicke's encephalopathy Pathway Ataxia T2 intensity of mamillary bodies Nystagmus Ophthalmoplegia Polyneuropathy Lab findings Lactic acidosis References 1. Galvin R, Br then G, Ivashynka A et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010 Dec;17 12 1408 18. Open https://web.pathway.md/diseases/reciIwhkRp6pibxdg 3/3