Pearls

Think CANON for signs of alcohol-induced amnesia

Author and Disclosure Information

 

References

Wernicke’s encephalopathy is often missed in clinical practice.1 Left untreated, the alcohol-induced amnestic disorder can progress to Korsakoff’s syndrome, a form of permanent short-term memory loss from which four out of five patients do not recover.2

Why Wernicke’s is missed

Lesions in the medial dorsal nucleus of the thalamus, hippocampus, and mammillary bodies cause signs and symptoms of Wernicke’s. Associated psychotic symptoms—including delusions, confusion, agitation, blunted to apathetic affect, and confabulation—may incorrectly suggest delirium tremens, alcohol-induced psychosis, delusional disorder, or dementia.

Key features of Wernicke’s are remembered with the acronym CANON:

Clouded consciousness with impaired orientation and inability to sustain attention to environmental stimuli.

Ataxia, primarily affecting gait

Nystagmus, mainly horizontal

Ophthalmoplegia accompanied by lateral orbital palsy and gaze palsy, which is usually bilateral. Anisocoria and a sluggish reaction to light also are present.

Neuropathy, mainly peripheral.

Early recognition and treatment is essential as early-stage Wernicke’s responds rapidly to parenteral thiamine, 100 mg/d for 5 to 7 days. Oral thiamine, 100 mg two to three times daily, is then given for 1 to 2 weeks.

Recommended Reading

Atypical Antipsychotics in Youth: Use Caution
MDedge Psychiatry
School-Based Intervention Helps Aggressive Kids Cope
MDedge Psychiatry
Experiencing Nature May Help to Quell ADHD
MDedge Psychiatry
Two ADHD Drugs Affect Sleep Differently
MDedge Psychiatry
Sleep Found Surprisingly Inadequate in Children of All Ages
MDedge Psychiatry
Imaging Can Match Brain Structure to Behavior
MDedge Psychiatry
Gay, Bisexual Teens Face Greater Parenthood Risk
MDedge Psychiatry
Explore Emotions of Atopic Dermatitis Patients
MDedge Psychiatry
Drugs Remain Secondary in Autism Treatment : Psychopharmacologic agents are frequently used but still do not correct the core deficits of the disorder.
MDedge Psychiatry
Link Found Between Maternal Asthma/Allergy and Autism
MDedge Psychiatry