Wernicke encephalopathy

Wernicke encephalopathy

    * Introduction
    * Pathophysiology
    * Clinical
    * Diagnosis
    * Treatment
First perosana that this condition was described neurologist Carl Wernicke in 1881. Wernicke encephalopathy is a syndrome characterized by ataxia, confusion, ophthalmoplegic and short-term memory impairment. The cause of this disease is considered to be represented by lesions in the nuclei talamici median body mamilari. It is also likely to result from the lesion in the upper portion vermisului. The disease frequently accompanies inadequate intake or poor absorption of thiamine (vitamin B1). In general, thiamine deficiency occurs in chronic users of alcohol misfeeds plus alcohol thiamine absorption in the gut slows. So the greatest risk of developing the disease have alcoholics. Thiamine deficiency meets the highest frequency in alcoholics. But there are other causes, less common, that interfere with thiamine deficiency such as gastric cancer patients, chronic gastritis, gastric surgery in the field. Wernicke encephalopathy is a common disease, but can be easily prevented by avoidance of thiamine deficiency in people with increased risk of developing this problem. Most people with this disease are alcoholic, but can occur in people malnourished dialysis patients, in AIDS and cancer. Affects male predilection, male-female ratio was 1, 7:1, probably because of higher incidence of alcoholism in men. The average age of onset of the disease is around 50 years, but may meet at any time of life, depending on the appearance of one of the problems and causes listed above.
Causes - Alcohol abuse is the most common cause of long-term. Alcoholism is frequently accompanies malnutrition and intestinal absorption of vitamin B1 is reduced by 70%. In serum, vitamin B1 has lower values from 30% to 98% compared to normal subjects. Alcohol alone, in the absence of malnutrition, can reduce intestinal absorption of vitamin B1 by 50%. - Second place in Wernicke encephalopathy cases is prolonged malnutrition. This is what happens when African populations, especially among children who were in need of vitamin B, they located in the growth period. Malnutrition associated with increased need for vitamin D during growth and lead to serious vitamin deficiencies and protein deficiencies, which are translated into physical and mental development. - Infectious diseases increase the body's need for vitamin B, as in the general metabolism is much faster infection, the patient is in a state hipercatabolica. Therefore, patients with infectious diseases is recommended vitamins and protein supplementation in the diet. Pneumonia and bacterial meningitis is most commonly associated with Wernicke encephalopathy. - Other factors: prolonged vomiting, sepsis (it increases vitamin requirements), gastric surgery, chronic gastritis, gastric cancer, hemodialysis. In infants fed only formula, they may develop encephalopathy in the absence of added vitamin B in milk. A study in 2008 revealed in a report Wernicke encephalopathy epidemic among infants in Israel who were fed formula without added thiamine. Manifestations of thiamine deficiency in infants are constipation, agitation, apathy, vomiting, poor appetite, and later meets diarrhea, nystagmus, seizures, unconsciousness and cardiomyopathy. - An iatrogenic cause is intravenous glucose solutions in excess. A single episode of this kind does not cause encephalopathy, which appeared only in case of excess administration of glucose solution is repeated regularly.