SUMMARY
Comparison with a selected group of alcohol-using patients has allowed clear definition of the characteristic features of subjects with Wernicke's encephalopathy. The majority were unemployed Australian men with a very high alcohol intake, thiamin deficiency and abnormal liver function tests. Gross nutritional status ranged from obesity to protein-energy malnutrition.
Ophthalmoplegia, nystagmus, abnormal c-ordination and peripheral neuropathy clearly differentiated patients with Wernicke's encephalopathy from other alcohol users. Brain atrophy, Korsakoff's psychosis and alcohol-related dementia were present in 100%, 100%, and 30% of tested subjects with Wernicke's encephalopathy, a much higher incidence than in hospital patients.
As the first preventative measure, the importance of reducing community and individual alcohol consumption is stressed. There is very inadequate evidence at present to support the addition of thiamin to beer in the prevention of the relatively few cases of Wernicke's encephalopathy, and there is no evidence supporting its use in the prevention of other types of alcohol-related brain damage.
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Notes on contributors
J. Santamaria
Both authors formerly Public Health Officers, Eastern Sydney Area Public Health Unit Previously general practitioner, Orange NSW, Australia.