title: [Wernicke's encephalopathy in non-alcoholic patients: a series of 8 cases].
abstract: BACKGROUND
  Wernicke's encephalopathy (WE) is an underdiagnosed condition, usually associated with alcoholism, and has a worse prognosis if there is a delay in diagnosis. A series of 8 non-alcoholic patients with WE is presented and an assessment is made on whether a delay in diagnosis leads to a worse prognosis.
  
  
  METHODS
  The clinical records of patients admitted to 2 university hospitals between 2004 and 2009 with the diagnosis of WE, excluding those with a history of alcoholism, were retrospectively reviewed.
  
  
  RESULTS
  The study included 4 men and 4 women aged 35-82 of whom 7 had a history of gastrointestinal pathology, and persistent vomiting was the precipitating factor in 7. Encephalopathy was the most frequent onset symptom (4). The classical triad was present in seven patients. Thiamine levels were low in 3/6 and normal in 3/6 cases. MRI was abnormal in seven patients, with high signal intensity in the diencephalon and mammillary bodies (7), periaqueductal grey matter (6), cortex (3) and cerebellum (1). Seven improved with thiamine. Sequelae were mild in 6, and severe in 2 after 6-12 months of follow-up. All patients with a diagnostic delay less than 18 days had mild sequelae.
  
  
  CONCLUSIONS
  Non-alcoholic WE frequently occurs after gastrointestinal disturbances that could result in lower thiamine absorption. Whereas thiamine levels can be normal in many cases, in almost all cases the MRI shows signal alterations in typical locations. A delay in the diagnosis, and therefore, in treatment leads to a worse prognosis.
authors.affiliation: Servicio de Neurología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. 32535jgb@comb.cat
authors.forename: J
authors.initials: J
authors.lastname: Gascón-Bayarri
authors.forename: J
authors.initials: J
authors.lastname: Campdelacreu
authors.forename: M C
authors.initials: MC
authors.lastname: García-Carreira
authors.forename: J
authors.initials: J
authors.lastname: Estela
authors.forename: S
authors.initials: S
authors.lastname: Martínez-Yélamos
authors.forename: A
authors.initials: A
authors.lastname: Palasí
authors.forename: T
authors.initials: T
authors.lastname: Delgado
authors.forename: R
authors.initials: R
authors.lastname: Reñé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013831:Thiamine / Q000627:therapeutic use; D014899:Wernicke Encephalopathy / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology
chemical_list: D013831:Thiamine