Talk:Wernicke encephalopathy

Sacks

I read in The Man Who Mistook His Wife For A Hat by Oliver Sacks that exterme bulimia can lead to Wernicke's encephalopathy. This agrees with the fact that prolonged vomiting is mentioned among the causes in the first paragraph of this article.

Should it be added?

--124.62.255.251 18:35, 14 September 2007 (UTC)

No (see WP:MEDRS-- secondary reviews are preferable). SandyGeorgia (Talk) 16:35, 9 July 2013 (UTC)

Introduction paragraph

I slightly edited the opening paragraph to better reflect that alcoholism, much less severe alcoholism, isn't a necessary prerequisite to developing this syndrome. Since the body does not stock thiamine (as it does with say, Vitamin A in the liver), and because alcohol interferes with its uptake, even excessive drinking over a few days can cause or significantly contribute to a deficiency that can lead to this syndrome. 68.196.122.197 12:30, 11 November 2007 (UTC)

This article's grammar is very poor and needs to be edited. 173.66.25.102 (talk) 00:35, 23 May 2013 (UTC)

This article is extremely poorly written, almost as if translated from another language. The layout is unsatisfactory. 17:23, 2nd June, 2013. — Preceding unsigned comment added by 152.78.160.135 (talk) 16:24, 2 June 2013 (UTC)

Introduction paragraph (2)

I've edited some small reference errors in the introduction. Maybe an expert can review this? Especially the last sentence.

Strompf (talk) 22:16, 18 March 2010 (UTC)

Short term memory and Wernicke's encephalopathy

impairment of short-term memory is a symptome of Korsakoff syndrome not Wernicke's encephalopathy, now indeed WE may be followed in long term by the Korsakoff syndrome and thus leading to short term deficit. But it's a whole new syndrome. — Preceding unsigned comment added by Medbenmedben (talk • contribs) 01:27, 11 December 2010 (UTC)

Newcastle & Fife

Some of the references are very local guidance documents that are not very suitable for encyclopedia content. National Institute for Health and Clinical Excellence. Clinical guideline 100: Alcohol-use disorders: physical complications. London, 2010. seems better. JFW | T@lk 16:51, 20 February 2013 (UTC)

Cleanup

I have marked this page for cleanup. This is for the following reasons:

• Standard of writing not following Neutral Point of View standard
• Link farming as previously removed from page
• Issues relating to structure and order. This article does not give distinguish between common and unusual symptomatology.
• Explanations are confusing and abbreviated.
• Claims are made which are not reflected in current English-language medical literature, including about the classification of subsets of beriberi, without adequate citation. This might be better labelled as controversy.
• Citations are not made properly.

This article could be improved if:

• Links were integrated as references into the article
• The article incorporated more English-language links
• Explanations, particularly of pathophysiology, were made more explicit.
• The style of writing used is according to Wikipedia's Neutral Point of View policy [[1]].

This is a fascinating topic and the content on this page is wonderful. However it could use some improvement. I will continue to work on improving this article and look forward to constructive dialogue with others involved. LT90001 (talk) 07:43, 12 June 2013 (UTC)

I came to this article for reference purposes and started cleanup but partial re-writes are not sufficient to save it. I will return after some consideration. Fydfyd (talk) 19:08, 12 June 2013 (UTC)

It was expanded extensively by an editor who has little experience with WP:MEDMOS, WP:MEDRS and citation templates. The cleanup would be a labour of love for which I currently do not have the time. Any improvements will be welcomed. JFW | T@lk 19:32, 12 June 2013 (UTC)

HEY

I re-posted the multiple issues warning box. I did that for a reason. The page is a mess. I don't know if the editors who have been working on this understand the English language. FYI-I have been in hospitals where I have seen with my own eyes, doctors and nurses who have "Googled" for medical information. I know that is not Wikipedia's responsibility, but it happens. -But for that reason, and also the atrocious mess of grammar, I am suspicious about the prescribing information. The warning at the top of the article should stay if only to warn people that the info. is suspect.24.0.133.234 (talk) 18:20, 8 July 2013 (UTC)

Agree. This article needs to be based on secondary sources per WP:MEDRS. Large number of primary sources keep getting added.Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:37, 8 July 2013 (UTC)

Ditto. This is not a case for cleanup by minor editing. It needs radical removal of all the unstructured mess that's been thrown in over the past few months: a revert back to (say) 20th February [2]. Gordonofcartoon (talk) 19:07, 8 July 2013 (UTC)

Yes looking at the changes it seems that they are primarily the addition of a large number of primary sources. Just because one subacute cause occurred in someone with gastric syphilis does not make it a cause.[3] Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:46, 9 July 2013 (UTC)

Well it has not even been a full day and an active editor of this article who is a self-named "researcher' of the topic has deleted the warning box, (again) after other editors came by and did some great work cleaning-up some of the citations. I re-added the warning because there are still citations/references that need to be checked, and the overall grammar/understandability of the article is still lacking. I am finding all kinds-of grammar/translation problems with the article, but I do not have the science background or access to medical journals to confirm the references and citations, so I am strongly recommending that the warning box remain at the top of the article until the entire thing has been verified by editors with better scientific/medical resources, and experience.24.0.133.234 (talk) 06:08, 9 July 2013 (UTC)

RE: User:Luis cerni edits to this article

OK so after some research, I have determined that the editor who has been adding a great deal of info. to this article is not a native speaker of the English language. That being said, I think that they have added to the topic. I am proposing that said editor, User:Luis cerni, in future edits to the article, please post edits here on the talk page, as opposed to the article directly, so that a translation can be applied before it is added to the article. 24.0.133.234 (talk) 06:13, 9 July 2013 (UTC)

Hi

It is unacceptable to have removed some of the common causes of Wernicke's encephalopathy: Excessive vomiting, Prolonged parenteral nutrition, anorexia, malabsorption of nutrients, thyrotoxicosis and renal dialysis. This is well documented in the references. I would appreciate more prudence and research on what they are modifying. The article has been reviewed and accepted by other American physicians. I can only accept my limitations in handling the language and the rules of Wikipedia. Please refrain from making unconstructive edits to Wikipedia. Luis ........Luis cerni (talk) 23:55, 9 July 2013 (UTC)— Preceding unsigned comment added by Luis cerni (talk • contribs) 18:57, July 9, 2013

Do you have secondary sources to support this? A single case study does not make these "causes". Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:24, 9 July 2013 (UTC)

Hi 2

The English is not my native language but I have written a serious article. Initially, with few references, but then I demanded that it should add references, and I attended that order. The article establishes the last criteria about a very common disease, and diagnosed only 10%, and which is surrounded by old notions and prejudices. So little is known that in the early years of bariatric surgeries, there was 94% of Wernicke encephalopathies. My work has provoked the interest of G Sechi, a reference in this encephalopathy, and has prompted the British Medical Journals ask me to correct an investigation. Mr. XX not judge if "do not have the science background or access to medical journals". Physicians, please investigate because the old criteria WE are causing many deaths and sufferings in 90% of patients who fail to be diagnosed, or are only treated with thiamine. If you have questions do not hesitate to contact me but not destroyed. Cheers, Luis cerni ........Luis cerni (talk) 23:55, 9 July 2013 (UTC)— Preceding unsigned comment added by Luis cerni (talk • contribs) 19:08, July 9, 2013

It isn't just an issue of English, there is a substantial amount of incorrect or misleading information in the article. For example the epidemiology section seriously misrepresents the literature. What the literature says is that in developed countries the great majority of cases are associated with alcoholism, but in underdeveloped countries (such Brazilian) a substantial number of cases are caused by malnutrition. Looie496 (talk) 19:22, 9 July 2013 (UTC)

LOOIE.....90% failure in diagnostics because of prejudice. With so many more failures should be investigated and reviewed texts that contradict research practices. What says Looie is a manifestation of the same, totally honest but misleading. You could read the research that was done in Recife, Brazil (in English), which classifies the cases, and is separated malnutrition (a very few). In developed countries, we know from multiple causes such as cancer and bariatric surgeries. Looie, thanks for discuss without destroying. If after inform you with all the references provided (including in Brazil), have questions, please write me. Of course, I will review epidemiology section, also there we have a lot to improved.Luis cerni (talk) 00:12, 10 July 2013 (UTC) — Preceding unsigned comment added by Luis cerni (talk • contribs) 20:45, July 9, 2013

Luis, it sounds like you are saying you disagree with reliable sources, and that the text you are adding based on primary sources amounts to original research or undue weight. If you will confine your editing to what is stated in sources that are compliant with Wikipedia guidelines for editing medical articlers, there is less chance your work will be deleted. Saludos, SandyGeorgia (Talk) 20:54, 9 July 2013 (UTC)

Hi 3

The modification you guys made ​​about hypothermia is incorrect. The classical definition is when the body temperature drops to 35 ° C.. But we refer to an incipient cooling caused by deregulation in the CNS, and that begins peripherally with cold skin, or the patient's sensation of cold. Initially not recorded in the thermometers placed in the trunk. This also is called hypothermia.Luis cerni (talk) 00:12, 10 July 2013 (UTC) — Preceding unsigned comment added by Luis cerni (talk • contribs) of 19:43, July 9, 2013

You need to provide links to edits. If you view that edit and provide the url we can then follow you. Not sure what you are referring to at this point. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:48, 9 July 2013 (UTC)

James, the link was provided, but is written in Spanish. It is a text written by Codina-Puiggros, a fundamental text of neurology. On page 824 says: "excessive sweating, cyanosis and coldness are frequent symptoms in the hands and feet of these patients." Hypothermia is a symptom absolutely accepted and Codina-Puiggros described in its beginning. I wrote it otherwise than I found it clearer ... perhaps ... but consistent with my personal experience.......Luis cerni (talk) 23:55, 9 July 2013 (UTC)

Please provide me a link that shows the removed text in question. I did not remove any comment concerning hypothermia in these edits that I can see [4] Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:52, 9 July 2013 (UTC)

James, I said "you gays", and you have responded. I never said it's you. I ask you to help me making contributions that apply. — Preceding unsigned comment added by Luis cerni (talk • contribs) 22:08, July 9, 2013

Okay well if you decide to provide a link I will look into it. Agree that not all of what was added is based on primary sources but much of it is and is of WP:UNDUE weight. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:16, 9 July 2013 (UTC)

Luis, favor de firmar tus entradas aqui entrando cuatro ~ (~~~~) al final de tus palabras. Si no firmas, se nos hace muy dificil entender la conversacion aqui. SandyGeorgia (Talk) 22:19, 9 July 2013 (UTC)

I was trying to fix the hypothermia info. That was me. It said ThisHypothermia to which we refer, not when the temperature falls below 35 º C[2]. It's when it starts to be reduced, specially peripherically, even before being posible to be recorded by the thermometer placed in the usual sites of measurement, but sufficient to promote the development of an infection. The first symptom may be feeling cold from the patient, then may follow mild chills, cold skin, moderate pallor, tachycardia, hypertension, tremor or piloerection. If not taken care of can evolve to a greater hypothermia. Requires external heat supply. that was confusing so I tried to make it understandable wit:"Hypothermia which is not related to ambient temperature,[3] can promote the development of an infection. The patient may report feeling cold ,followed by mild chills, cold skin, moderate pallor, tachycardia, hypertension, tremor or piloerection. External warming techniques are advised to prevent hypothermia."

I'm not sure what you mean? I thought you were trying to differentiate between outside and internal body temperature? Maybe it should say 95° Fahrenheit? Normal body temperature in American terms is around 98.6°. It could say both, but what exactly does it mean anyways? I left in the part about chills and cold skin, so I'm not sure what the exact temperature is supposed to mean?24.0.133.234 (talk) 01:43, 10 July 2013 (UTC)

Also It says this:,b>As often happens in neurological diseases, this encephalopathy can be exacerbated by the reduction in body temperature, physical exertion, infections, or certain drugs. This neurological deterioration is potentially dangerous because it predisposes the patient to hypothermia and decreased immunity, facilitating superimposed infections which in turn further aggravate the disease.[68] To overcome this cycle, as been proposed a neurological treatment. Possible infections would cause will continue to release cytokines, that would cause new adverse events from affected areas of the brain, and therefore the treatment can be effective only surpassed the infection. Gabapentin, by its relation to the inhibitory neurotransmitter GABA, has been tried prophylactically three times a day in low doses to reduce the effects and number of disordered responses to adverse external stimuli.[67],----I'm going to try and fix-up the grammar there too, but this seems to be saying almost the same thing about temperature?24.0.133.234 (talk) 01:47, 10 July 2013 (UTC)

OK-I think I understand about the temperature although the info. is mentioned elsewhere in the article and maybe should be merged into that paragraph? How about if I change it to: Although hypothermia is usually diagnosed with a body temperature of 35 º C or 95° Fahrenheit, or less, incipient cooling caused by deregulation in the CNS, needs to be monitored because it can promote the development of an infection...."?24.0.133.234 (talk) 02:38, 10 July 2013 (UTC)

2º source

ABOUT some erased common causes......................................... . MEDLINEPLUS............... " Malabsortion. Other conditions that may cause thiamine deficiency include: AIDS Cancers that have spread throughout the body. Extreme nausea and vomiting during pregnancy (hyperemesis gravidarum). Heart failure (when treated with long-term diuretic therapy). Long periods of intravenous (IV) therapy without receiving thiamine supplements. Long-term dialysis. Very high thyroid hormone levels (thyrotoxicosis). . http://www.nlm.nih.gov/medlineplus/ency/article/000771.htm

List of cases of Wernicke encephalopathy reported in non alcoholic subjects

CLINICAL CONDITION........................ No.  %  
Cancer.....................................113 18.1 
Gastrointestinal surgery...................105 16.8
Hyperemesis gravidarum......................76 12.2
Starvation/Fasting..........................64 10.2
Gastrointestinal tract diseases.............48 7.7
AIDS........................................31 5.0
Malnutrition................................26 4.2 
Dialysis and renal diseases.................24 3.8
Parenteral nutrition........................24 3.8
Vomiting....................................15 2.4
Psychiatric-diseases........................15 2.4
Stem cell/marrow transplantation............14 2.2
Infections...................................9 1.4
Intoxication.................................9 1.4
Thyroid-diseases.............................8 1.3
Unbalanced diet..............................6 1.0 
Iatrogenic...................................5 0.8
Hypoxic encephalopathy.......................2 0.3
Unknown etiology............................19 3.
Total....................................625 cases.100.0%

EFNS.(European Federation of Neurol. Societ.) Search performed in Medline, Embase, LILACS from data-base inception through May 31, 2009.........^ EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. R. Galvin, G. Bra ˚then, A. Ivashynka, M. Hillbom, R. Tanasescu and M. A. Leone. EFNS Guidelines/CME articles.

http://www.researchgate.net/publication/45273962_EFNS_guidelines_for_diagnosis_therapy_and_prevention_of_Wernicke_encephalopathy

. ............... Luis cerni (talk) 23:52, 9 July 2013 (UTC)

I had to look up "remotion"--dictionary says, ". The act of removing; removal. 2. The state of being remote.". This is an unfamiliar term for most English-speakers. This information, (co-morbid conditions), is in the article now? or you would like to add it? Or add the citation?24.0.133.234 (talk) 01:22, 10 July 2013 (UTC)

. . 24.0.133. Thanks for your answer and teach. I would like to be completed the list of risk factors as above provided, or to be left as I originally wrote. Someone cut causes that are out of discussion. Luis cerni (talk) 20:32, 11 July 2013 (UTC)

O. K.

I have read this page again and found it excellent. Thank you very much to those who helped. I chose Wiki by its global reach, there are doctors who consult from a child pc in remote places, without acces to publications. But any where and every body read the Wiki. We have relieved a lot of suffering. Cheers, Luis. Luis cerni (talk) 21:45, 11 July 2013 (UTC)

I agree with you-I am very satisfied with the improvements! And yes I have seen it with my own eyes, in American hospitals. Like it or not Wikipedia and Google are used by practitioners in the field. Keeping that in mind, I think that the current content with a multitude of differential diagnoses, and co-morbidity, are a great resource. The chemistry could probably still use a little work but I'll leave that for future editors.24.0.133.234 (talk) 22:44, 14 July 2013 (UTC)

Primary sources

There continues to be addition of primary sources such as one I removed here [5]. The source is here http://www.ncbi.nlm.nih.gov/pubmed/?term=15687431 Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:43, 20 July 2013 (UTC)

The reference formatting is also in need of fixing. We have a combination of non-templated citations, raw URLs, and other stuff. I am also not thrilled about the reliance on non-English sources, as there are enough English language sources to make this article comprehensive. Some of them are already quite old (e.g. Cook's article from 2000 cited in the introduction).

As for the text, I have removed some redundancy from the introduction but there is still plenty of it in the rest of the article. JFW | T@lk 07:14, 26 August 2013 (UTC)

Wiki Education assignment: Reading and Writing in the Natural Sciences

This article was the subject of a Wiki Education Foundation-supported course assignment, between 9 January 2023 and 28 April 2023. Further details are available on the course page. Student editor(s): MRH2002! (article contribs). Peer reviewers: Srh030, Delbel4567.

— Assignment last updated by H2Oworks (talk) 17:50, 23 March 2023 (UTC)