Snapshot A 44-year-old male presents with confusion and gait instability. Medical history is significant for alcohol use disorder, requiring multiple hospitalizations for alcohol intoxication. He drinks one to two pints of vodka daily. On exam, he appears inattentive, has bilateral horizontal nystagmus, and his gait is slow and wide-based. Introduction Wernicke-Korsakoff (WK) syndrome login to view 7 more bullets Pathophsiology Certain metabolic enzymes use thiamine as a cofactor login to view 4 more bullets Epidemiology Alcoholics are mostly affected Presentation Symptoms login to view 9 more bullets Evaluation Clinical diagnosis login to view 1 more bullet Thiamine level login to view 2 more bullets Erythrocyte thiamine transketolase login to view 1 more bullet Differential Alcohol intoxication Early Alzheimer's disease Treatment Intravenous thiamine login to view 2 more bullets Complications lead to Korsakoff syndrome if Wernicke's encephalopathy is not treated Prevention adeqaute thiamine intake