A Study On The Clinical Characteristics Of Alcoholic And Non-alcoholic Wernicke’s Encephalopathy

ObjectivesTo investigate the clinical characteristics of Wernicke’s encephalopathy(WE),and to compare the differences between alcoholic and non-alcoholic WE patients in terms of etiology,clinical manifestations,imaging,laboratory tests and outcome at discharge,in order to enhance clinicians’ understanding of WE and provide reference for the diagnosis and management of WE.MethodsPatients who were hospitalized and diagnosed with WE in the First and Fifth Affiliated Hospital of Zhengzhou University from June 2012 to July 2020 were retrospectively analyzed and divided into alcoholic WE and non-alcoholic WE groups according to whether combined a history of long-term heavy drinking.The differences in clinical characteristics between the two groups were compared using parametric or non-parametric tests.ResultsA total of 74 WE patients were enrolled(55 males and 19 females),with a mean onset age of 50.2±15.5 years.Mental abnormalities or disturbance of consciousness were the most common typical symptoms(79.7%),followed by cerebellar dysfunction(60.1%).Only a few patients presented with oculomotor disorders(29.7%),and only 8.1% had all the three WE-related typical symptoms.WE-related imaging changes were observed on magnetic resonance in some patients(39.1%),among which cerebral cortex(20.3%),cerebellum(18.8%),midbrain parietal and periaqueduct(14.1%),and thalamus(14.1%)were more commonly involved.All patients were given vitamin B1 and symptomatic supportive treatment during hospitalization,and the majority of patients(83.8%)achieved a good prognosis(complete or partial recovery)upon discharge.As for subgroup comparison,there were 33 patients in the alcoholic WE group and 41 patients in the non-alcoholic WE group.In contrast,the alcoholic WE group contained more males(P <0.001),had a higher prevalence of smoking(P <0.001),had more common cerebellar dysfunction(P=0.018),showed more cerebellar involvement(P =0.011)and cerebral atrophy(P =0.027)on imaging,and were more likely to be accompanied by hypomagnesemia(P =0.014)and elevated liver enzymes(P =0.026).Patients in the non-alcoholic WE group had the most common causes including internal diseases of digestive system(26.8%)and post-gastrointestinal surgery(21.9%),were more likely to have anemia(P =0.035),hyperlipidemia(P=0.018)and increased fasting glucose(P =0.031),and had a higher proportion of good prognosis upon discharge(P =0.021).ConclusionsPatients with WE tend to have a middle-aged onset,male predominance,and mental abnormalities or disturbance of consciousness are most common.About 1/3 of the patients can see WE-related imaging changes,and long-term heavy drinking,internal diseases of digestive system and post-gastrointestinal surgery are the most common causes.Patients with alcoholic and non-alcoholic WE may have differences in clinical manifestations,imaging,laboratory tests,and outcome at discharge,which deserve clinical attention.Timely supplementation of vitamin B1 help to improve the prognosis of WE patients.