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Wernicke encephalopathy — RCPSC IM MCQ

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HardNeurologyWernicke encephalopathyRCPSC IM

A 58-year-old man with alcohol use disorder is admitted with confusion, ataxia and horizontal nystagmus. He has eaten poorly for weeks. Glucose is 3.4 mmol/L and magnesium is low. CT head shows no acute lesion. What is the most appropriate management?

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Correct answer: E — Intravenous thiamine before glucose-containing fluids when possible, with magnesium repletion

The triad of confusion, ataxia and ocular findings in malnutrition suggests Wernicke encephalopathy. Parenteral thiamine should be given urgently, ideally before glucose, with magnesium repletion.

Reference: Canadian neurology and addiction medicine guidance