Wernicke's syndrome not just for malnourished alcoholics any more

Ataxia, confusion and opthalmoplegia, the classic triad of Wernicke's, that all the IM residents at Charity Hospital were aware of and had the IV thiamin at the ready is said to only occur in about 20% of the cases. Our index of suspicion was aimed at the malnourished alcoholic but now it sometimes can be a disease of medical progress-to the extent that gastric bypass for obesity is considered progress. Medscape presents a CME case of a young woman some few months post op from gastric by-pass whose astute physicians were able to diagnose and treat it. Apparently the MRI has some fairly typical findings.Recovery is variable and the ocular palsy resolves first but ataxia may persist as may the memory problems.How commonly it is associated with by pass association is unclear.A recent report from Brazil documents 4 cases.Vomiting may be the trigger as it seemed to be in two cases reported from Spain.Another case reported from South America described a man with no vomiting but with rather marked voluntary reduction in food intake which lead to this thiamin deficiency syndrome. It is clearly something to be aware in a gastric-bypass patient with vomiting as early treatment can reverse much of the abnormal neurological picture but not always all of it.What about prevention?