WE is an acute, potentially reversible neurological disorder caused by a deficiency in or severe depletion of thiamine (vitamin B1) that can result from chronic alcoholism, poor nutrition, long-term parenteral feeding, hyper emesis gravi darum or bariatric surgery.7,8 Incidence rates of WE in the general population—on the basis of autopsy findings in Western countries—range from 0.1–2.8%, but can be as high as 12.5% in patients with alcoholism.9,10 Such individuals are at a high risk of thiamine deficiency because of the poor diet associated with their lifestyle, and the fact that chronic alcoholism compromises thiamine absorption from the gastro intestinal tract, impairs thiamine storage, and may reduce the phosphorylation of thiamine to its biologically active form, thiamine pyrophosphate (TPP; Figure 2).11–15
