Wernicke’s Encephalopathy: Beyond the Classic Triad

Wernicke's encephalopathy may not present with the classic triad of confusion, ophthalmoplegia, and gait instability. Have a high suspicion and low treatment threshold. Brain imaging, especially CT, may be normal in Wernicke's encephalopathy. Don't rely solely on imaging to make the diagnosis. Give high-dose IV thiamine (500 mg TID for 7 days) to treat Wernicke's, even if Korsakoff syndrome is suspected, as some cognitive recovery is possible.