Antonio J Chamorro1, Beatriz Rosón-Hernández2, José-A Medina-García3, Roberto Muga-Bustamante4, Joaquín Fernández-Solá5, M-Candelaria Martín-González6, Elena Seco-Hernández7, Ignacio Novo-Veleiro8, Carlos Suárez-Cuervo9, Ana M Mateos-Díaz1, Rafael Monte-Secades10, Begoña Machado-Prieto11, Rubén Puerta-Louro12, Cristina Prada-González13, Álvaro Fernández-Rial14, Patricia Sabio-Repiso15, Rocío Vázquez-Vigo16, Ana-C Antolí-Royo17, Aina Gomila-Grange2, Nieves-C Felipe-Pérez3, Arantza Sanvisens-Bergé4, Emilia Antúnez-Jorge5, Camino-M Fernández-Rodríguez6, Lucía Alvela-Suárez8, Alba Fidalgo-Navarro9, Miguel Marcos18. 1. Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain. 2. Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain. 3. Department of Internal Medicine, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain. 4. Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 5. Department of Internal Medicine, Hospital Clínic, Barcelona, Spain. 6. Department of Internal Medicine, Hospital Universitario de Canarias, Tenerife, Spain. 7. Department of Internal Medicine, Complexo Hospitalario Universitario de Ourense, Ourense, Spain. 8. Department of Internal Medicine, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain. 9. Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain. 10. Department of Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain. 11. Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Vigo, Spain. 12. Department of Internal Medicine, Hospital de Povisa, Vigo, Spain. 13. Department of Internal Medicine, Hospital del Bierzo, Ponferrada, León, Spain. 14. Department of Internal Medicine, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain. 15. Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain. 16. Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain. 17. Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain. 18. Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain. Electronic address: mmarcos@usal.es.
Abstract
OBJECTIVE: To analyze the differences in characteristics and prognosis between alcoholic and nonalcoholic patients with Wernicke encephalopathy (WE). PATIENTS AND METHODS: A retrospective observational cohort of 468 patients diagnosed with WE with at least 2 Caine criteria was selected from all patients discharged with a diagnosis of WE from 21 medical centers in Spain from January 1, 2000, through December 31, 2012. Demographic, clinical, and outcome variables were described. RESULTS: Among the 468 patients, the most common risk factor was alcoholism (n=434 [92.7%]). More than one-third of patients (n=181 [38.7%]) had the classic WE triad of symptoms (ocular signs, cerebellar dysfunction, and confusion). Among 252 patients for whom magnetic resonance imaging data were available, 135 (53.6%) had WE-related lesions and 42 (16.7%) had cerebellar lesions. Of the 468 patients, 25 (5.3%) died during hospitalization. Alcoholic patients presented more frequently than nonalcoholic patients with cerebellar signs (P=.01) but less frequently with ocular signs (P=.02). Alcoholic patients had a significantly higher frequency of hyponatremia (P=.04) and decreased platelet count (P=.005) compared with nonalcoholics. Alcoholic patients were diagnosed earlier than nonalcoholics (median time to diagnosis, 1 vs 4 days; P=.001) and had shorter hospitalizations (13 vs 23 days; P=.002). CONCLUSION: Compared with nonalcoholic patients, alcoholic patients with WE are more likely to present with cerebellar signs and less likely to have ocular signs. Diagnosis may be delayed in nonalcoholic patients. Mortality in the present series was lower than described previously.
OBJECTIVE: To analyze the differences in characteristics and prognosis between alcoholic and nonalcoholic patients with Wernicke encephalopathy (WE). PATIENTS AND METHODS: A retrospective observational cohort of 468 patients diagnosed with WE with at least 2 Caine criteria was selected from all patients discharged with a diagnosis of WE from 21 medical centers in Spain from January 1, 2000, through December 31, 2012. Demographic, clinical, and outcome variables were described. RESULTS: Among the 468 patients, the most common risk factor was alcoholism (n=434 [92.7%]). More than one-third of patients (n=181 [38.7%]) had the classic WE triad of symptoms (ocular signs, cerebellar dysfunction, and confusion). Among 252 patients for whom magnetic resonance imaging data were available, 135 (53.6%) had WE-related lesions and 42 (16.7%) had cerebellar lesions. Of the 468 patients, 25 (5.3%) died during hospitalization. Alcoholicpatients presented more frequently than nonalcoholic patients with cerebellar signs (P=.01) but less frequently with ocular signs (P=.02). Alcoholicpatients had a significantly higher frequency of hyponatremia (P=.04) and decreased platelet count (P=.005) compared with nonalcoholics. Alcoholicpatients were diagnosed earlier than nonalcoholics (median time to diagnosis, 1 vs 4 days; P=.001) and had shorter hospitalizations (13 vs 23 days; P=.002). CONCLUSION: Compared with nonalcoholic patients, alcoholicpatients with WE are more likely to present with cerebellar signs and less likely to have ocular signs. Diagnosis may be delayed in nonalcoholic patients. Mortality in the present series was lower than described previously.
Authors: Salahuddin Nasir; Moustafa Abou Areda; Elise L Ma; Robert D Chow; Avelino Verceles; Carol Chiung-Hui Peng Journal: J Community Hosp Intern Med Perspect Date: 2021-01-26
Authors: Gabriele A Vassallo; Antonio Mirijello; Tommaso Dionisi; Claudia Tarli; Giuseppe Augello; Antonio Gasbarrini; Giovanni Addolorato Journal: J Clin Med Date: 2020-11-25 Impact factor: 4.241