EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy

Wernicke encephalopathy should be suspected in any condition that can cause thiamine deficiency, not only in alcohol use. In people who drink heavily, diagnosis needs two of four signs: dietary deficiency, eye signs, cerebellar dysfunction, and altered mental state or mild memory impairment. Total thiamine in blood should be measured immediately before treatment and MRI can support the diagnosis. Thiamine 200 mg three times a day, preferably intravenous and before any carbohydrate, is recommended. After bariatric surgery, follow-up for at least 6 months and parenteral supplementation are advised.