Wernicke ’ S Encephalopathy Revisited

Aims: A translation into English of the case history section of Carl Wernicke’s original manuscript of 1881, with a discussion on its relevance for clinicians today. Methods: A copy of Carl Wernicke’s original German text was obtained by one of the authors (CCHC) and translated into English from the old German by a professional translator. Results: The translation was subsequently agreed by native German speaking referees, and minor changes made. Conclusion: The authors studied the translation in detail and concluded that Wernicke’s description had stood the test of time. The diagnosis of Wernicke’s Encephalopathy remains a clinical one. It is 125 years since Carl Wernicke published his Lehrbuch der Gehirnkrankheiten fur Aerte and Studirende in 1881 (Figure 1) in which he described a new disease, based on clinical and pathological observations in three patients (Wernicke, 1881). It is also 100 years since the first description of Alzheimer’s disease (Alzheimer, 1904). Both of these diseases cause devastating neurological sequelae and neither has specific ante-mortem diagnostic tests. Recent publications estimate that approximately 24.3 million people in the world have some form of dementia (Ferri et al., 2005), indicating an urgent need, where possible, to identify the cause of the dementia and to institute preventative or early and effective treatment before irreversible damage occurs. The concept of a “classic triad” of signs and symptoms in Wernicke’s Encephalopathy (WE) was based on the original description by Wernicke. The triad consists of an abrupt onset of a confusional state and impairment of consciousness, ataxia and eye signs (nystagmus and ophthalmoplegia). Similarly, Victor et al . (1989) in their famous monograph concluded: “The diagnosis of Wernicke’s disease is made most readily on the basis of the acute appearance of ocular palsies, nystagmus, ataxia of gait, and disturbances of consciousness and mentation, which may present singly or in various combinations. More than 80% of patients show signs of polyneuropathy as well, and associated liver disease is found in two thirds of the patients” (Victor et al ., 1989). However, as Wernicke himself described, and has been shown in subsequent studies, other important clinical signs and symptoms, such as nausea, vomiting, loss of appetite and emotional changes, are often present before the later “classical” signs appear. *Author to whom correspondence should be addressed at: National Addiction Centre, Box 048, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK. Tel: 0044 (0) 203228 2345; Fax: 0044 (0) 203228 2349; E-mail: [email protected] We are not aware of any English translation of Wernicke’s original German paper so this was organized by one of us (CCHC) and is presented below. Wernicke described the early signs and symptoms of his eponymous encephalopathy in three untreated patients. WERNICKE’S CLINICAL DESCRIPTIONS