Differences Between Alcoholic and Nonalcoholic Patients With Wernicke Encephalopathy: A Multicenter Observational Study.
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Chamorro Antonio J, Rosón-Hernández Beatriz, Medina-García José-A, Muga-Bustamante Roberto, Fernández-Solá Joaquín, Martín-González M-Candelaria, Seco-Hernández Elena, Novo-Veleiro Ignacio, Suárez-Cuervo Carlos, Mateos-Díaz Ana M, Monte-Secades Rafael, Machado-Prieto Begoña, Puerta-Louro Rubén, Prada-González Cristina, Fernández-Rial Álvaro, Sabio-Repiso Patricia, Vázquez-Vigo Rocío, Antolí-Royo Ana-C, Gomila-Grange Aina, Felipe-Pérez Nieves-C, Sanvisens-Bergé Arantza, Antúnez-Jorge Emilia, Fernández-Rodríguez Camino-M, Alvela-Suárez Lucía, Fidalgo-Navarro Alba, Marcos Miguel, Wernicke-SEMI Group, Alcohol and Alcoholism Group, Spanish Society of Internal Medicine (SEMI)
Аннотация
PATIENTS AND METHODS: A retrospective observational cohort of 468 patients diagnosed with WE with at least 2 Caine criteria was selected from all patients discharged with a diagnosis of WE from 21 medical centers in Spain from January 1, 2000, through December 31, 2012. Demographic, clinical, and outcome variables were described.
RESULTS: Among the 468 patients, the most common risk factor was alcoholism (n=434 [92.7%]). More than one-third of patients (n=181 [38.7%]) had the classic WE triad of symptoms (ocular signs, cerebellar dysfunction, and confusion). Among 252 patients for whom magnetic resonance imaging data were available, 135 (53.6%) had WE-related lesions and 42 (16.7%) had cerebellar lesions. Of the 468 patients, 25 (5.3%) died during hospitalization. Alcoholic patients presented more frequently than nonalcoholic patients with cerebellar signs (P=.01) but less frequently with ocular signs (P=.02). Alcoholic patients had a significantly higher frequency of hyponatremia (P=.04) and decreased platelet count (P=.005) compared with nonalcoholics. Alcoholic patients were diagnosed earlier than nonalcoholics (median time to diagnosis, 1 vs 4 days; P=.001) and had shorter hospitalizations (13 vs 23 days; P=.002).
CONCLUSION: Compared with nonalcoholic patients, alcoholic patients with WE are more likely to present with cerebellar signs and less likely to have ocular signs. Diagnosis may be delayed in nonalcoholic patients. Mortality in the present series was lower than described previously.