• Wernicke encephalopathy is due to thiamine deficiency, often seen in alcoholics (which is a common NBME way of suggesting patient may have nutritional deficiency) and leads to triad of confusion, ataxia and ophthalmoplegia
• Key idea: Patients presenting to ED with altered mental status of unknown etiology often given glucose, thiamine and naloxone, but a commonly tested concept on NBME exams is that patients should get thiamine before glucose because glucose first can induce Wernicke encephalopathy in patient with underlying nutritional deficiency
• Chlordiazepoxide would be used in patient with alcohol withdrawal or delirium tremens (autonomic hyperactivity would be more prominent in presentation)

• Patient with chronic alcoholism present with confusion, ataxia and ophthalmoplegia, most consistent with Wernicke encephalopathy secondary to thiamine deficiency
• Key idea: On the NBME exam, patient with alcoholism = patient with malnutrition and vitamin deficiencies (among other associations)

Wernicke triad:

1. Oculomotor dysfunction -- (dysconjuugate gaze and prominent nystagmus)
2. gait ataxia -- (difficulty walking, can only stand with assistance, wide base)
3. Encephalopathy -- (confusion, disoriented)

Treat with thiamine.

This patient has wernicke's encephalopathy secondary to alcohol abuse. The tx is Thiamine, Vit b1. They also can have damage to their mamilary body