Coma and hypothermia in Wernicke's encephalopathy.

Two patients who developed Wernicke's Encephalopathy with subsequent hypothermia are described. Both patients responded rapidly to thiamine administration and one later had hypothalamic-pituitary function tests performed. This patient demonstrated depressed TSH response to TRH and a sluggish early cortisol response to adequate hypoglycaemia compared to 17 control subjects. These findings may suggest that previously described hypothalmic-pituitary abnormalties in chronic alcoholics may be mediated via thiamine deficiency and may also reflect hypothalamic damage contributing to the hypothermic state. The importance of intravenous thiamine administration in cases of coma of unknown aetiology is emphasised.