To the Editor.—
It has been recognized that Wernicke's encephalopathy is significantly underdiagnosed during life.1-4 Many physicians learn to look for this disorder only in patients with chronic alcoholism.4 Reuler et al3 note this syndrome is "even less frequently considered in the nonalcoholic population." We have noted that Wernicke's encephalopathy is infrequently considered when a history of alcoholism is absent, despite malnutrition.
We evaluated our medical and neurological house staff's knowledge of Wernicke's encephalopathy by reading a vignette to 40 consecutive residents doing a rotation on the neurology service between May 1986 and May 1987. The following vignette was read to each resident: "You are a physician in the emergency room and you are asked to see a 63-year-old woman with a history of stomach cancer who is brought to the ER because of confusion. She is not able to really give you much more history.
Sands GH, Mulloy K. Wernicke's Syndrome: What We Don't Teach. JAMA. 1987;258(18):2530. doi:10.1001/jama.1987.03400180064025