Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 24-15: Wernicke Encephalopathy & Korsakoff Syndrome + Key Features Download Section PDF Listen +++ ++ Caused by thiamine deficiency In United States, occurs most commonly in patients with alcohol use disorder It may also occur in patients with AIDS, in patients with hyperemesis gravidarum, or after bariatric surgery + Clinical Findings Download Section PDF Listen +++ ++ Wernicke syndrome Triad of confusion, ataxia, and nystagmus leading to ophthalmoplegia (lateral rectus muscle weakness, conjugate gaze palsies) Peripheral neuropathy may be present Korsakoff syndrome Occurs in more severe cases of thiamine deficiency Includes anterograde and retrograde amnesia and sometimes confabulation May not be recognized until after an initial delirium has lifted + Diagnosis Download Section PDF Listen +++ ++ Confirmed by the response to treatment within 1 or 2 days, which must not be delayed while laboratory confirmation is obtained + Treatment Download Section PDF Listen +++ ++ In suspected cases, thiamine 100 mg, is given intravenously immediately and then intramuscularly on a daily basis until a satisfactory diet can be ensured after which the same dose is given orally Initial doses of 200–500 mg intravenously three times daily for the first 5–7 days of treatment has been recommended Intravenous glucose given before thiamine may precipitate the syndrome or worsen the symptoms