Wernicke's encephalopathy in a chronic alcoholic is precipitated by glucose administration without prior thiamine in patients with thiamine deficiency. The classic triad consists of which three features?

• A Nystagmus, peripheral neuropathy, confabulation
• B Ataxia, confabulation, and amnesia
• C Tremor, delirium, and tachycardia
• D Ophthalmoplegia (nystagmus/conjugate gaze palsy), ataxia, and confusion/altered consciousness ✓

Explanation

The classic Wernicke's encephalopathy triad is: (1) Ophthalmoplegia — lateral rectus palsy (CN VI), nystagmus, or conjugate gaze palsy; (2) Cerebellar ataxia (wide-based gait); and (3) Confusion/altered consciousness. Confabulation is a feature of Korsakoff syndrome — the chronic amnestic sequel to Wernicke's. In practice, all three features are present together in only ~16% of cases; clinical suspicion warrants empirical IV thiamine (500 mg TDS) before glucose administration.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.