Wernicke's encephalopathy in a funny patient

Sojer and colleagues describe a diabetic patient presenting with a month of periodic cognitive impairment due to hypoglycaemia.¹ However, a sentence of indispensable personal history should have been included. Significant alcohol consumption could raise a possibility of Wernicke's encephalopathy. This disease is often unrecognized but detrimental if left untreated. The classic triad of mental status change, ophthalmoplegia and truncal ataxia is present in only 16% of patients.² Failure to include this encephalopathy among differentials of mental status change in such patients and to give intravenous thiamine before glucose accordingly in the setting of hypoglycaemia would lead the patient to worsening status.²

Last but not least, I have seen quite a few alcoholics, and have learnt that a practical question should be ‘when was your last drink?’ rather than ‘do you use alcohol?’