Wernicke’s encephalopathy: symptoms, thiamine treatment and recovery

Thiamine, or vitamin B1, is needed by brain cells to work properly. The Alzheimer’s Society explains that a lack of it can have severe and long-lasting effects on the brain. Wernicke–Korsakoff syndrome has two separate stages. First there is a brief time when a person has intense inflammation (swelling) of the brain, which is Wernicke’s encephalopathy. If this is not treated quickly, the person may develop Korsakoff’s syndrome.

It can be confused with dementia but is different. The Alzheimer’s Society says some of the symptoms may be similar to dementia but it is not a type of dementia. Alcohol Change UK describes alcohol-related brain damage more broadly as a cluster of conditions, and says its progress can be halted and even reversed.

Although alcohol is the commonest cause, the underlying problem is the lack of thiamine. The Alzheimer’s Society links the deficiency to alcohol because heavy drinkers often eat a poor diet and the gut can no longer absorb enough thiamine from food.

The Alzheimer’s Society says earlier signs of Wernicke’s encephalopathy include a poor appetite, feeling sick, vomiting or recent weight loss. A person may feel faint or dizzy, get pins and needles in their hands and feet, have blurred vision or see double.

It says that if a person who drinks heavily develops any of the following, they should seek urgent medical attention from their GP or call NHS 111. Some people may have only one or two of these, which can make an emergency difficult to spot, and it can be even harder to recognise if the person is still intoxicated or experiencing withdrawal.

• Being confused, disorientated, drowsy or less responsive.

• Seeing things that are not there (hallucinations).

• Difficulty controlling eye movements.

• Poor balance, being unsteady and walking with legs wide apart.

• Being undernourished, for example being thin or having lost a lot of weight recently.

The Alzheimer’s Society says most people with Wernicke’s encephalopathy will be disorientated and confused, which is called delirium, and that this is a medical emergency. It describes Wernicke–Korsakoff syndrome as a serious medical condition that should be treated in hospital.

Anyone who is confused, unsteady or has abnormal eye movements, particularly with a history of heavy drinking or poor nutrition, needs same-day medical assessment. If someone is severely drowsy or cannot be woken, call 999.

The sources used here do not describe a single definitive test, so recognition relies on the history, the symptoms above and a physical examination. Alcohol Change UK lists a history of heavy drinking over many years, prolonged cognitive impairment and vitamin B1 deficiency among the factors that prompt clinicians to look for alcohol-related brain damage.

It adds that a thorough physical assessment should always take place at the time of diagnosis, because people may also have liver damage, heart problems, high blood pressure and malnutrition. Scans such as MRI can help confirm specific elements by showing changes in the brain, and cognitive tests are used to assess memory and thinking, although the charity says none of the tests is a specific diagnostic tool.

The Alzheimer’s Society says treatment is in hospital with regular thiamine injections and medication to control withdrawal symptoms. Alcohol Change UK describes the first phase of treatment as physical stabilisation and withdrawal, with high doses of vitamin B1 by drip or injection under medical supervision in hospital, sometimes known by the commercial name Pabrinex.

The same charity describes five phases of treatment, from the acute stage to long-term rehabilitation. The Alzheimer’s Society warns that anyone who may have alcohol-related brain damage should not try to stop drinking by themselves without proper medical support.

The Alzheimer’s Society says about a quarter of the people affected who get treatment make a good recovery, about half make at least some recovery but still need support to manage their lives, and for some people the damage is mostly permanent. It says recovery might not be possible because of too much damage, or because the person continues to drink.

Alcohol Change UK puts the position for alcohol-related brain damage generally as around 75 per cent of people who receive treatment making some recovery, with the best chance of improvement if they stop drinking altogether. People with Korsakoff’s syndrome who do not fully recover may need specialist long-term residential care if unable to live independently, and the Alzheimer’s Society says specialist homes can be hard to find locally.

Support comes through the NHS and through voluntary organisations such as the ARBD Network, which the Alzheimer’s Society signposts. Private rehabilitation services exist for alcohol dependence but the acute emergency is always managed through an NHS hospital.