- Chronic alcohol abuse
- Others w/severe nutritional deficiency: anorexia/bulimia, hyperemesis gravidarum, s/p gastric bypass, TPN w/o supplementation, other states with chronically poor intake
- Delirium - with range of severity in confusional state; mild forms may predominantly affect memory
- Balance problems (ataxia), extremity numbness (peripheral neuropathy - dry Beri Beri)
- Occulomotor dysfunction leading to double vision or other occular disturbances
- Wernicke encephalopathy: most patients wont have all 4 (confusion, ataxia, ophthalmoplegia, nutritional depletion); To diagnose, need to have 2 of 4
- Symptoms typically develop over days to a few weeks
- Symptoms resolve w/thiamine, occulmotor most quickly; typically within hours to days
- If untreated, can lead to coma and death; also to Korsakoff's dementia→ permanent inability to form new memories
- Wet Beri Beri: High output heart failure→ SOB, PND, orthopnea
- Variable levels of confusion
- Cranial nerve palsy (in particular CN6→ lateral rectus)
- Severe ataxia→ often unable to stand
- Persistent vertical and/or horizontal nystagmus
- If high output heart failure: rales on lung exam, elevated JVP, edema
- Peripheral neuropathy
- Can assess B1 levels
- MRI findings can be in: mammillary bodies, thalamus, cerebellum