Causes of WE

Q: Describe few causes of Wernicke encephalopathy (WE) besides chronic alcoholism?

Answer: The objective of this question is to highlight the stereotyping of WE occurring only in patients with chronic alcoholism. About one-forth of patients with WE has a cause other ETOH abuse. There are many other causes of WE. Any or combination of following four factors of thiamine deficiency can cause WE.

1.  inadequate dietary intake
2. decreased gastrointestinal (GI) absorption, 
3. reduced liver storage, and 
4. impaired utilization

Some of the conditions beside chronic alcohol abuse which can cause WE are

• Anorexia nervosa 
• Poor diet
• Hyperemesis gravidarum
• GI pathology 
• Bariatric surgery
• Malignancy 
• Transplant
• Hemo or peritoneal dialysis
• AIDS
• Genetic disorder of thiamine metabolism 

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References:

1. Lindboe CF, Løberg EM. Wernicke's encephalopathy in non-alcoholics. An autopsy study. J Neurol Sci 1989; 90:125.

2. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007 May;6(5):442-55. doi: 10.1016/S1474-4422(07)70104-7. PMID: 17434099.