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Wernicke s encephalopathy is characterized by confusion, ataxia, and nystagmus leading to ophthalmoplegia (lateral rectus muscle weakness, conjugate gaze palsies); peripheral neuropathy may also be present It is due to thiamine deficiency and in the United States occurs most commonly in alcoholics It may also occur in patients with AIDS or hyperemesis gravidarum, and after surgery for obesity In suspected cases, thiamine (50 mg) is given intravenously immediately and then intramuscularly on a daily basis until a satisfactory diet can be ensured Intravenous glucose given before thiamine may precipitate the syndrome or worsen the symptoms The diagnosis is confirmed by the response in 1 or 2 days to treatment, which must not be delayed while laboratory confirmation is obtained

Thomson AD et al The natural history and pathophysiology of Wernicke s encephalopathy and Korsakoff s psychosis Alcohol Alcohol 2006 Mar Apr;41(2):151 8 [PMID: 16384871]

Stuporous patients respond only to repeated vigorous stimuli Comatose patients are unarousable and unresponsive

IEnumerable<Box> resultList = from myBox in boxList where myBox.Length > 3 && myBox.Width > 3 select myBox;

ing in the arms accompanied by flaccidity or slight flexor responses in the legs in patients with extensive brainstem damage extending down to the pons at the trigeminal level

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The patient who is stuporous is unresponsive except when subjected to repeated vigorous stimuli, while the comatose patient is unarousable and unable to respond to external events or inner needs, although reflex movements and posturing may be present Coma is a major complication of serious central nervous system disorders It can result from seizures, hypothermia, metabolic disturbances, or structural lesions causing bilateral cerebral hemispheric dysfunction or a disturbance of the brainstem reticular activating system A mass lesion involving one cerebral hemisphere may cause coma by compression of the brainstem

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1 Pupils Hypothalamic disease processes may lead to unilateral Horner s syndrome, while bilateral diencephalic involvement or destructive pontine lesions may lead to small but reactive pupils Ipsilateral pupillary dilation with no direct or consensual response to light occurs with compression of the third cranial nerve, eg, with uncal herniation The pupils are slightly smaller than normal but responsive to light in many metabolic encephalopathies; however, they may be fixed and dilated following overdosage with atropine, scopolamine, or glutethimide, and pinpoint (but responsive) with opiates Pupillary dilation for several hours following cardiopulmonary arrest implies a poor prognosis 2 Eye movements Conjugate deviation of the eyes to the side suggests the presence of an ipsilateral hemispheric lesion or a contralateral pontine lesion A mesencephalic lesion leads to downward conjugate deviation Dysconjugate ocular deviation in coma implies a structural brainstem lesion unless there was preexisting strabismus The oculomotor responses to passive head turning and to caloric stimulation relate to each other and provide complementary information In response to brisk rotation of the head from side to side and to flexion and extension of the head, normally conscious patients with open eyes do not exhibit contraversive conjugate eye deviation (doll s-head eye response) unless there is voluntary visual fixation or bilateral frontal pathology With cortical depression in lightly comatose patients, a brisk doll s-head eye response is seen With brainstem lesions, this oculocephalic reflex becomes impaired or lost, depending on the site of the lesion The oculovestibular reflex is tested by caloric stimulation using irrigation with ice water In normal subjects, jerk nystagmus is elicited for about 2 or 3 minutes, with the slow component toward the irrigated ear In unconscious patients with an intact brainstem, the fast component of the nystagmus disappears, so that the eyes tonically deviate toward the irrigated side for 2 3 minutes before returning to their original position With impairment of brainstem function, the response becomes perverted and finally disappears In metabolic coma, oculocephalic and oculovestibular reflex responses are preserved, at least initially.

Usually occurs after 7 10 days of antibiotics Can occur after a single dose or several weeks after completion of antibiotics 1 8 days

Enterohemorrhagic Escherichia coli, including E coli O157:H7 and other Shiga-toxin producing strains (STEC) Enterotoxigenic E coli (ETEC) Vibrio parahaemolyticus

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