For those who do not, no specific measures can hasten the process or improve the outcome. Symptoms and signs develop acutely. Patients may become ataxic, confused, drowsy, or stuporous. Nystagmus and partial ophthalmoplegia are characteristic. An acute cerebellar ataxia frequently develops in association with these symptoms.
Most patients have underlying nutritional deficiencies.
Although Wernicke's encephalopathy is a fairly common diagnosis, it is often missed or delayed, with unfortunate results. Treatment of suspected or borderline cases consists of giving parenteral thiamine 100 mg IV immediately, especially before administering fluids containing glucose. The next steps are rehydration to restore blood volume, correction of electrolyte abnormalities, and initiation of general nutritional therapy, including multivitamins. Advanced cases require hospitalization and close supervision. Korsakoff's syndrome often develops after a severe or repeated attack of postalcoholic delirium tremens, whether or not a typical attack of Wernicke's encephalopathy has occurred first.