title: Wernicke's Encephalopathy: Increasing Clinician Awareness of This Serious, Enigmatic, Yet Treatable Disease.
abstract: OBJECTIVE
  Undiagnosed and/or undertreated Wernicke's encephalopathy can result in permanent brain damage, long-term institutionalization, and death. The purpose of this article is to heighten clinical awareness of Wernicke's encephalopathy and shed light on its diagnosis and treatment, which are often inconsistent due to unclear diagnostic criteria and limited practice guidelines. An update on the management of Wernicke's encephalopathy is presented and several case reports and a quality improvement project from our hospital are described.
  
  
  METHODS
  PubMed, the Cochrane Database of Systematic Reviews, and PsycINFO were searched for English-language articles published between January 1991 and January 2014 using combinations of the following keywords: Wernicke's encephalopathy, diagnosis, treatment/guideline(s), and thiamine.
  
  
  METHODS
  The automated search identified over 500 articles. A manual review of the related citations and reference lists from articles of interest was also conducted. The articles reviewed were chosen on the basis of author consensus and because they represented expert opinion or the highest quality of evidence available.
  
  
  RESULTS
  Diagnostic criteria are reviewed in this article and should be used to diagnose Wernicke's encephalopathy with high sensitivity and specificity. The European Federation of Neurologic Societies and the Royal College of Physicians issued national guidelines for the diagnosis, prevention, and treatment of Wernicke's encephalopathy. No benchmark national guidelines for treating Wernicke's encephalopathy exist in the United States.
  
  
  CONCLUSIONS
  Whenever Wernicke's encephalopathy is suspected, treatment should be initiated immediately with intravenous thiamine because oral thiamine is inadequate for preventing permanent brain damage. An adequate dose of intravenous thiamine administrated in a timely manner is a safe and life-saving treatment for Wernicke's encephalopathy that could preserve brain cells and function.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita (Drs Flynn, Macaluso, and D'Empaire) and Via Christi Hospitals (Dr Troutman), Wichita, Kansas.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Flynn
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita (Drs Flynn, Macaluso, and D'Empaire) and Via Christi Hospitals (Dr Troutman), Wichita, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Macaluso
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita (Drs Flynn, Macaluso, and D'Empaire) and Via Christi Hospitals (Dr Troutman), Wichita, Kansas.
authors.forename: Inna
authors.initials: I
authors.lastname: D'Empaire
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita (Drs Flynn, Macaluso, and D'Empaire) and Via Christi Hospitals (Dr Troutman), Wichita, Kansas.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Troutman