Diagnosis and treatment of Wernicke's encephalopathy: A systematic literature review

source extracted confidence: high 2026-04-09
#humans #thiamine #vitamin-b-complex #wernicke-encephalopathy

Diagnosis and treatment of Wernicke's encephalopathy: A systematic literature review

Cantu-Weinstein et al., 2024 | Gen Hosp Psychiatry | Systematic Review

Citation

Cantu-Weinstein Ashley, Branning Rachel, ... Anand Akhil. Diagnosis and treatment of Wernicke's encephalopathy: A systematic literature review. Gen Hosp Psychiatry. 2024;87:48-59. doi:10.1016/j.genhosppsych.2024.01.005

Abstract

BACKGROUND: Wernicke's encephalopathy (WE) is a serious neurological disorder that is underdiagnosed. Despite limited clinical guidelines, the standard use of intravenous (IV) thiamine is underutilized and remains an area of research deserving much attention. OBJECTIVES: We conducted a systematic review using Medline, Embase, and CENTRAL databases to identify and summarize the literature on IV thiamine treatment in WE. Human studies with WE patients who received ≥100 mg of thiamine IV met inclusion criteria. Randomized controlled trials, cross-sectional studies, and case reports were included. RESULTS: A total of 27 studies were included: 20 case reports, five retrospective studies, one prospective study and one randomized control trial. Of the case reports, 11 (55%) cases were female, and the average age of all cases was 45 years (SD = 15). The other seven studies included 688 patients; the average age was 52 years (SD = 9), and 266 (38.7%) were female. Among the case reports, neurological and clinical findings were used to diagnose WE in 16 (80%) cases. MRI was utilized to diagnose 15 (75%) cases. 500 mg IV thiamine TID was reported in 12 case reports (60%). 18 (90%) of case reports had partial or complete resolution of symptoms following IV thiamine. CONCLUSION: IV thiamine can alleviate neurological symptoms, cognitive dysfunction, and brain imaging lesions associated with WE. We found key limitations in the evidence for IV thiamine and diagnostic standards for WE. Future targeted research should establish clear diagnostic and treatment guidelines for WE to prevent this serious condition from being underdiagnosed or undertreated.

Key Findings

A total of 27 studies were included: 20 case reports, five retrospective studies, one prospective study and one randomized control trial. Of the case reports, 11 (55%) cases were female, and the average age of all cases was 45 years (SD = 15). The other seven studies included 688 patients; the average age was 52 years (SD = 9), and 266 (38.7%) were female. Among the case reports, neurological and clinical findings were used to diagnose WE in 16 (80%) cases. MRI was utilized to diagnose 15 (75%)

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 688
Age Range See abstract
Condition cognitive

MeSH Terms

  • Humans
  • Thiamine
  • Vitamin B Complex
  • Wernicke Encephalopathy

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review
  • Vertical: thiamine

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09