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Wernicke encephalopathy — SCE Neurology MCQ

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EasyCognitive NeurologyWernicke encephalopathySCE Neurology

A 48-year-old man with alcohol dependence is admitted with confusion, unsteady gait and horizontal nystagmus. He has been vomiting for a week and is hypoglycaemic. He has not eaten properly for several days. CT head is normal. What is the most appropriate management?

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Correct answer: D — Give intravenous thiamine before glucose

Give intravenous thiamine before glucose is the best answer. Confusion, ataxia and ophthalmoplegia in a malnourished patient require urgent parenteral thiamine before carbohydrate to prevent worsening Wernicke encephalopathy. Glucose first can precipitate deterioration; outpatient review is unsafe; haloperidol does not treat thiamine deficiency; fluid restriction treats SIADH, not this syndrome. Clinical pearl: The classic triad is incomplete in many patients, so treatment should be empirical when suspected.

Reference: NICE alcohol-use disorders guidance; BNF