Caine criteria for timely diagnosis of Wernicke-Korsakoff síndrome in Ecuador
Abstract
Introduction: Wernicke-Korsakoff syndrome (WKS) is a neurological condition secondary to thiamine deficiency, comprising Wernicke's encephalopathy (acute and potentially reversible) and Korsakoff's syndrome (chronic and irreversible). Although traditionally associated with alcoholism, it also occurs in contexts of malabsorption, severe infections, and neoplasms. In Ecuador, it represents a concern due to high alcohol consumption among young people aged 19 to 24 years.
Objective: To analyze effective diagnostic methods for their timely implementation in the Ecuadorian healthcare system to prevent irreversible neurological sequelae.
Methods: A narrative review was conducted from September to October 2025 through structured searches in PubMed, Scopus, SciELO, ScienceDirect, and Google Scholar. Descriptors in Spanish and English were used ("Wernicke encephalopathy," "Caine criteria," among others), prioritizing literature from 2020 to 2025.
Results: The classic triad (ophthalmoplegia, ataxia, and confusion) showed low sensitivity, as only 10,0 % of cases presented the complete triad. The Caine criteria, which require two out of five elements—cerebellar signs, oculomotor abnormalities, dietary deficiencies, altered mental status, or memory impairment—increased diagnostic sensitivity from 23,0 % to 85,0 %. Magnetic resonance imaging showed limited utility with 53,0 % sensitivity.
Conclusions: WKS remains underdiagnosed due to reliance on the classic triad. The adoption of the Caine criteria in Ecuadorian protocols would enable early diagnosis, timely thiamine treatment, and prevention of permanent sequelae in resource-limited settings.
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