Wernicke's Encephalopathy and High-Dose Nitroglycerin

Excerpt

To the editor: The long-recognized cause of Wernicke-Korsakoff encephalopathy has been thiamine deficiency, associated with poor nutrition in the alcoholic or nonalcoholic patient. Blass and Gibson (1) suggested a different cause, namely a genetic abnormality in transketolase, the thiamine-requiring enzyme. Even in their four patients, however, nutritional deprivation was necessary before the genetic expression appeared. Hence, nutritional deprivation has been a common theme in this disease.

Shorey and associates (2) propose that high doses of the diluent ethyl alcohol and propylene glycol given intravenously may produce this disease by a direct metabolic effect on thiamine metabolism. These authors should exclude