sailor girlWernicke-Korsakoff syndrome

Alternative names:
Korsakoff psychosis; alcoholic encephalopathy; encephalopathy, alcoholic; Wernicke's disease

A brain disorder involving loss of specific brain functions, due to thiamine deficiency.

Causes, incidence, and risk factors:
Wernicke-Korsakoff syndrome usually affects people between 40 and 80 years old. The onset is gradual.

The syndrome is actually two disorders that may occur independently or together. Wernicke's disease 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 B-1 (thiamine), which commonly accompanies habitual alcohol use or alcoholism.

Korsakoff syndrome, or Korsakoff psychosis, involves impairment of memory and intellect/cognitive skills such as problem solving or learning, along with multiple symptoms of nerve damage. The most distinguishing symptom is confabulation (fabrication) where the person makes up detailed, believable stories about experiences or situations to cover the gaps in the memory. Korsakoff psychosis involves damage to areas of the brain.

Minimal or moderate alcohol use and adequate nutrition reduce the risk of developing Wernicke-Korsakoff syndrome.


Note: Symptoms that indicate alcohol withdrawal may also be present or may develop.

Signs and tests:
History is significant for chronic alcohol use. Examination of the nervous/muscular system may show polyneuropathy (damage to multiple nerve systems). Reflexes may be decreased or of abnormal intensity, or abnormal reflexes may be present. Testing of gait and coordination indicate damage to portions of the brain that control muscle coordination. Muscles may be weak and may show atrophy (loss of tissue mass). Examination of the eyes shows abnormalities of eye movement. Blood pressure and body temperature measurement may be low; pulse (heart rate) may be rapid. The person may appear cachectic (malnourished).

A nutritional assessment may confirm malnourished state, serum B-1 levels may be low, pyruvate is elevated, and transhetolase activity is decreased. Serum or urine alcohol levels may be elevated (see toxicology screen).

A cranial 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 (vitamin B-1) may improve symptoms of confusion or delirium, difficulties with vision and eye movement, and muscle incoordination. B-1 may be given by injection into a vein or a muscle, or by mouth. Thiamine does not generally improve loss of memory and intellect associated with Korsakoff psychosis.

Total abstinence from alcohol is required to prevent progressive loss of brain function and damage to peripheral nerves. A well-balanced, nourishing diet is recommended.

Expectations (prognosis):
Without treatment, Wernicke-Korsakoff syndrome progresses steadily to death. With treatment, symptoms such as incoordination and vision difficulties may be controlled, and progression of the disorder may be slowed or stopped. Some of the symptoms, particularly the loss of memory and intellect/cognitive skills, may be permanent. There may be a need for custodial care if the loss of intellect/cognitive skills is severe. Other disorders related to the abuse of alcohol may also be present.


Calling your health care provider:
Call your health care provider if Wernicke-Korsakoff syndrome is present and symptoms worsen or reappear. Also call if new symptoms develop, including symptoms of alcohol withdrawal:

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.


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