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DEAR DR. ROACH: How is "wet brain" (or Wernicke encephalopathy, WE) diagnosed? My son has been in the hospital, a rehab facility, and now an assisted living facility. Is there hope that he may walk again? He does not have any motivation and stays in bed most days playing on his phone. He hates being at a retirement home because he is 45, but he can't take care of himself. He has lost his family and career because of alcohol.

The physical therapist told me that he has wet brain. The doctor said it is a neuropathy and that his brain is shrinking. Please advise; we are seeking help for him to get better and out on his own. -- M.L.J.

ANSWER: WE is caused by a lack of thiamine (vitamin B1). (I had never heard the term "wet brain" to describe this illness, but I see it used sometimes. When I hear "wet brain," I think of hydrocephalus, a condition of too much fluid in the brain, but this is clearly not what you are asking about.)

Over 90% of cases of WE are associated with alcohol use. People with chronic, heavy alcohol use often do not get adequate thiamine from food, and in addition, alcohol can affect the absorption of thiamine and its storage in the liver. It is likely that there are genetic variants of metabolic enzymes that predispose a person to getting WE.

There are three classic findings in WE. The first is encephalopathy, which is characterized by disorientation, a poor attention span, and general indifference. Expert exams reveal the second issue: paralysis of certain eye muscles. Gait abnormalities are the third set of classic findings, with a gait where the feet are wide apart, consisting of slow steps.

Both the eye movement and gait disorders are a type of neuropathy caused by low thiamine. His doctor mentions shrinking of the brain ("atrophy"), which is common in WE but not at all specific.

A late manifestation of the encephalopathy is a condition called Korsakoff syndrome, in which there is profound amnesia. Some people develop confabulation -- making up stories that are completely untrue but make sense in the context of a conversation. It is thought that people with Korsakoff syndrome are unaware of their condition.

I wish I had better news for your son on the possibility of recovery, as only rapid and immediate administration of thiamine is effective at resolving symptoms. If a person did not get adequate thiamine, then most people do not recover completely. If he has not gotten better, the outlook is poor, although I have read about a handful of cases where people with this condition improved after some months.

DEAR DR. ROACH: I am an 80-year-old female on Eliquis who has many bruises on her legs that do not go away. Is there a remedy for this situation? -- R.D.T.

ANSWER: Eliquis is an anticoagulant; it reduces the body's ability to make blood clots by affecting clotting factors. We are all constantly breaking small blood vessels, but in people in their 80s, blood vessels are a bit more fragile and are prone to break with minor trauma. Even people who aren't on anticoagulants can develop bruising on their arms or legs. But when a person is on apixaban (Eliquis) or a similar drug, the anticoagulant is most likely the cause.

Some nutrients that are found in fruits and vegetables can help the blood vessels stay stronger, so a healthy diet is probably your best bet to reduce bruising.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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