wernicke’s encephalopathy
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Encephalopathy, or disrupted brain function, can have any number of causes; but one form frequently abetted by substance use disorder is Wernicke’s encephalopathy (named for Carl Wernicke, who first described the condition in 1881). While Wernicke’s is mercifully rare (less than 2 percent of the U.S. population are known to experience it), people with alcohol addiction are in the highest-risk group (drinking heavily increases the risk at least sixfold).

What Causes Wernicke’s Encephalopathy?

The condition is not caused by direct effects of alcohol, but by a thiamine deficiency resulting from insufficient consumption of vitamin-B1-rich foods such as meat, beans, nuts, and whole grains. Thiamine plays a vital role in regulating nerve functions and metabolism—and if thiamine is not regularly replenished through vitamin B1 intake, the average human body uses up its supply in about a month. Deprived of thiamine, the brain may start to “bleed” (hemorrhage) and lose its ability to regulate thinking and muscle control.

One reason people with alcohol use disorder are especially prone to Wernicke’s encephalopathy is that when alcohol dominates everyday life, people tend to consume it at the expense of other, healthier food items, including thiamine sources. In addition, someone with alcohol use disorder is prone to vomiting episodes (which deplete the body of nutrients) and to various illnesses that can further upset metabolism. (Chemotherapy, eating disorders, and bariatric surgery are also potential contributing factors to thiamine deficiency.)


Wernicke’s encephalopathy is characterized by mental and physical dysfunction:

  • Sleep problems
  • Loss of appetite
  • Frequent vomiting
  • Lightheadedness
  • Concentration difficulties or brain fog
  • Poor coordination
  • Muscle tremors and eye twitches
  • Seeing double
  • Symptoms similar to alcohol withdrawal: anxiety, mood swings, pounding heart, cold sweats, headaches.

If the problem is properly diagnosed at this stage, doses of Vitamin B1 (usually administered by medical injection) can help the patient make a full recovery. If left untreated, however, Wernicke’s encephalopathy has at least an 80 percent chance of progressing to Korsakoff syndrome, also called Korsakoff’s psychosis, alcohol dementia, or, commonly, “wet brain.” 

When Wet Brain Develops

Wet brain is not the same thing as “water on the brain,” which refers to unhealthy levels of cerebrospinal fluid (evidenced by headaches and poor balance, and treated by implanting shunt tubes to channel excess fluid away from the brain). A person with wet brain will suffer from:

  • Intensified encephalopathy symptoms
  • Serious memory problems (often combined with attempts to “fill in the blanks” by claiming obviously false statements as legitimate memories)
  • Hallucinations.

By the “wet brain” stage, much brain damage is typically permanent. In the worst-case scenario, thiamine-deficiency effects can be deadly—and where not immediately fatal, they may continue to progress and ultimately cause significant reductions in life expectancy.

What to Do about Wernicke’s Encephalopathy or Wet Brain

If you even suspect that you or another person are experiencing alcohol-related brain bleeding, get medical assistance immediately. And be sure to specifically mention the possibility of thiamine deficiency. Remember, the faster an accurate diagnosis and the earlier the treatment, the better the recovery prognosis—and since Wernicke’s encephalopathy and wet brain are rare, even medical specialists may not think to check thiamine levels(mistaking the symptoms for intoxication or other health problems) until significant damage has already been done. (One clue indicating Wernicke’s is that symptoms come on with unusual suddenness.)

Whether or not lasting damage is done, anyone treated for Wernicke’s encephalopathy or wet brain needs medical advice—and often ongoing treatment by specialists—to prevent the problem or its aftereffects from causing further harm.

  • A dietician can advise on eating to maintain healthy thiamine levels in the future. 
  • If reduced brain function fails to resolve itself after initial treatment, the patient should consult a neurologist on ways to maximize the chances of long-term improvement. 
  • Any future alcohol consumption will increase the risk of encephalopathy or wet-brain symptoms returning—meaning that the only safe course is permanent abstinence. Where alcohol addiction is a factor, however, “just quitting” is both difficult and dangerous, so treatment by an addiction-medicine specialist is essential.

Most important: don’t lose hope! Even where brain damage is serious, proper treatment and positive attitude can do much to improve quality of life. Get help and get busy making the most of what you still have!

Prevent Disability: Get Treated for Addiction

Wet brain isn’t the only serious health issue that can result from overuse of alcohol or other drugs. If you or someone in your family has a substance addiction, prompt treatment for that disorder may make the difference between a healthy future and permanent disability. Hope by the Sea offers medical detox and rehab programs customized to your treatment needs: contact us today to learn more. Hope Starts Here!