Abstract
Recently the number of patients with vitamin B_1 deficiency including Wernicke encephalopathy has increased were mainly in the aged population. The new problems of nutritional, medical and social backgrounds have to be studied. Wernicke encephalopathy is an acute neuropsychiatric syndrome resulting from vitamin B_1 deficiency. Criteria for diagnosing Wernicke encephalopathy requires the presence of three clinical signs, oculomotor abnormalities, cerebellar dysfunction, and confusion. However, it has often been reported that most patients do not fulfill all three criteria. According to autopsy-based studies, the disorder is still underdiagnosed. Even diagnosing the disorder, an insufficient treatment is followed by mental sequelae such as Korsakoff syndrome. The guideline of treatment of Wernicke encephalopathy is not established in Japan. The patients should be treated empirically with a minimum of 500mg thiamine (dissolved in 100 ml of normal saline), given by infusion over a period of 30 min, three times per day for 2〜3 days. In cases of no response, supplementation may be still continued for a few day. The clinical manifestations may be iatrogenically precipitated by glucose loading in the patients. To avoid this complication, thiamine must be administered prior to glucose infusion. Other vitamins including B_2, B_6, nicotinamide, and C should be additionally given, because multivitamin could be deficient in the patients.
