Caine et al developed criteria for the diagnosis of Wernicke's encephalopathy in a chronic alcoholic. Alcoholics are at increased risk for Wernicke's encephalopathy associated with thiamine deficiency. The authors are from Royal Prince Alfred Hospital, Prince of Wales Medical Research Institute and the University of Sydney in Australia.


Patient selection: chronic alcoholic (population with an increased pre-test probability)


Criteria for Wernicke's encephalopathy - 2 or more of the following:

(1) dietary deficiencies (malnutrition, undernutrition, vitamin deficiencies, etc)

(2) oculomotor abnormalities (gaze palsy, nystagmus, ophthalmoplegia)

(3) cerebellar dysfunction (ataxia, unsteady gait, abnormal past pointing, etc)

(4) one or both of the following:

(4a) altered mental status (disoriented, confused, stupor or coma)

(4b) mild memory impairment


The presence of hepatic encephalopathy may make the diagnosis of Wernicke's encephalopathy more difficult and easier to miss.


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