Autopsy prevalence of Wernicke's encephalopathy in alcohol-related disease

Objective. To determine the autopsy prevalence of Wernicke's encephalopathy (WE) in patients dying from alcohol-related diseases. Design. Prospective postmortem macroscopic and microscopic examination. Setting. Adult autopsies at King Edward VIII Hospital. Methods. Thirty-one consecutive autopsies were performed on patients who had died from alcohol-related diseases; these formed the study group. The control group comprised 10 patients with a negative history of alcohol and alcohol-related diseases. After examination of the brain, samples for histology were taken from the mamillary bodies and the wall of the third ventricle. Two subjects were excluded on account of additional unrelated brain pathology. Results. Of the 29 patients studied, 17 (59%) were confirmed histologically to have WE. The histological lesions were classified as either acute (5), acute on chronic (9) or chronic (3) according to defined pathological criteria. Macroscopic abnormalities were not obvious in any of the patients in the study group. Chart analysis revealed that a disturbance of the mental state was the commonest neurological finding (9/17). Ocular palsy was not present in any of the subjects. Although 2 patients had been given thiamine prior to death, a clinical diagnosis of WE was not made in any of the cases studied. Conclusion. This study proves that WE is a frequent finding in blacks with alcohol-related diseases. The high prevalence of WE found in adult autopsies (6.6%) without documented clinical evidence may have contributed to the mortality in these cases.