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Alternative namesKorsakoff psychosis; Alcoholic encephalopathy; Encephalopathy - alcoholic; Wernicke's disease
DefinitionWernicke-Korsakoff syndrome is a brain disorder involving loss of specific brain functions caused by a thiamine deficiency .
Causes, incidence, and risk factorsThe syndrome is actually a spectrum, including two separate sets of symptoms, one of which tends to start when the other subsides. Wernicke's encephalopathy involves damage to multiple nerves in both the central nervous system (brain and spinal cord) and the peripheral nervous system (the rest of the body).
It may also include symptoms caused by alcohol withdrawal . The cause is generally attributed to malnutrition, especially lack of vitamin B1 ( thiamine ), which commonly accompanies habitual alcohol use or alcoholism .
Heavy alcohol use interferes with the metabolism of thiamine, so even in the unusual cases where alcoholics are eating a balanced diet while drinking heavily, the metabolic problem persists because most of the thiamine is not absorbed.
Patients often attempt to hide their poor memory by confabulating. The patient will create detailed, believable stories about experiences or situations to cover gaps in memory. This is not usually a deliberate attempt to deceive because the patient often believes what he is saying to be true. It can occur whether or not the thiamine deficiency was related to alcoholism and with other types of brain damage.
Korsakoff psychosis involves damage to areas of the brain involved with memory.
Signs and tests
The person may appear cachectic (malnourished). A nutritional assessment may confirm malnourished state.
If the history is significant for chronic alcohol abuse , serum or urine alcohol levels may be elevated (see toxicology screen ) and liver enzymes may be elevated.
Other chronic conditions that may cause a thiamine deficiency include the following:
A brain MRI rarely shows changes in the tissue of the brain indicating Wernicke-Korsakoff syndrome.
The goals of treatment are to control symptoms as much as possible and to prevent progression of the disorder. Hospitalization is required for initial control of symptoms.
If the person is lethargic , unconscious , or comatose , monitoring and care appropriate to the condition may be required. The airway should be monitored and protected as appropriate.
Thiamine does not generally improve loss of memory and intellect associated with Korsakoff psychosis.
Support GroupsThe stress of illness can often be helped by joining a support group where members share common experiences and problems. See alcoholism - support group .
Without treatment, Wernicke-Korsakoff syndrome progresses steadily to death. With treatment, symptoms (such as uncoordinated movement and vision difficulties ) may be controlled, and progression of the disorder may be slowed or stopped.
Some symptoms -- particularly the loss of memory and cognitive skills -- may be permanent. There may be a need for custodial care if the loss of cognitive skills is severe.
Other disorders related to the abuse of alcohol may also be present.
Wernicke's encephalopathy may be precipitated in at-risk people by carbohydrate loading or glucose infusion. Supplementation with thiamine must precede glucose infusion to prevent this.
Calling your health care provider
Call your health care provider if symptoms suggesting Wernicke-Korsakoff syndrome occur, or if the condition has been diagnosed and symptoms worsen or reappear.
Also call if new symptoms develop, particularly symptoms of alcohol withdrawal. Alcohol withdrawal can be fatal, so call the local emergency number (such as 911) or go to the emergency room if any severe symptoms occur.
Symptoms of alcohol withdrawal include:
Delirium or confusion
PreventionAbstinence or moderate alcohol use and adequate nutrition reduce the risk of developing Wernicke-Korsakoff syndrome. If a heavy drinker is determined not to quit, thiamine supplementation and a good diet may help prevent the development of this condition, but not if damage has already occurred.
Update Date: 7/28/2002Elaine T. Kiriakopoulos, M.D., MSc, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT