Are Alcoholics Really at Fault for Their Crimes?

Courtesy of Godoy Medical Forensics


In April, I covered delirium and noted that there are many underlying etiologies that can cause it. One such etiology is Wernicke encephalopathy.

What is encephalopathy?

Encephalopathy is a general term describing any disease of the brain that alters the function or structure of the brain. There are many types of encephalopathy and causes.  The hallmark of encephalopathy is an altered mental state.  Depending on the type and severity of encephalopathy, common neurological symptoms are: progressive loss of memory and cognitive ability, subtle personality changes, inability to concentrate, lethargy. and progressive loss of consciousness.  (NIH 2018).

What is Wernicke encephalopathy (WE)?

Wernicke encephalopathy is an acute neurologic complication as a result of thiamine (vitamin B1) deficiency. The classic triad is encephalopathy, ataxic gait, and some variant of oculomotor dysfunction, so symptoms will include the following:

  • Memory impairment.
  • Mental confusion.
  • Paralysis or weakness of the eye muscles.
  • Vision problems.
  • Lack of muscle coordination or uncoordinated gait.

When WE becomes chronic and the symptoms persist, it is known as Wernicke-Korsakoff syndrome. This syndrome is irreversible.

Causes of Thiamine (Vitamin B1) deficiency:

B1 deficiency causes damage to parts of the brain.  The majority of affected patients have chronic alcoholism.  Other causes of thiamine deficiency include:

  • Acquired immunodeficiency Syndrome (AIDS).
  • Chronic diarrhea.
  • Dialysis.
  • Malnutrition.
  • Poor nutrition or dietary intake.

How does this relate to criminal cases?

The majority of patients with Wernicke encephalopathy are chronic alcoholics. The correlation between alcoholism and crime is well established, with some reports indicating that alcohol is a factor in approximately 50% of crimes. Just being drunk does not excuse culpability, but a medical condition like Wernicke encephalopathy may mitigate the circumstances. WE is reversible through replacement of Thiamine (banana bag) and this treatment may be subtle in a medical chart, especially if the defendant was treated for a traumatic injury at the same time. A review by a medical expert is beneficial to determine if the defendant was suffering from Wernicke encephalopathy.