Wernicke-Korsakoff Syndrome
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Definition
Wernicke-Korsakoff syndrome is a brain disorder due to thiamine deficiency.
Alternative Names
Korsakoff psychosis; Alcoholic encephalopathy; Encephalopathy - alcoholic; Wernicke's disease
Causes, incidence, and risk factors
Wernicke's encephalopathy and Korsakoff syndrome are different conditions that are both due to brain damage caused by a lack of vitamin B1 (thiamine).
A lack of vitamin B1 is common in people with alcoholism. It is also common in persons whose bodies do not absorb food properly (malabsorption), such as sometimes occurs after obesity surgery.
Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke's symptoms go away. Wernicke's encephalopathy causes brain damage in lower parts of the brain called the thalamus and hypothalamus. Korsakoff psychosis results from damage to areas of the brain involved with memory.
References
Brust JCM. Nutrition and alcohol-related neurologic disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 443.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Korsakoff psychosis; Alcoholic encephalopathy; Encephalopathy - alcoholic; Wernicke's disease
Symptoms
Symptoms of Wernicke's encephalopathy:
- Confusion
- Loss of muscle coordination (ataxia)
- Vision changes
- Abnormal eye movements (back and forth movements called nystagmus)
- Double vision
- Eyelid drooping
Symptoms of Korsakoff syndrome:
- Inability to form new memories
- Loss of memory, can be severe
- Making up stories (confabulation)
- Seeing or hearing things that aren't really there (hallucinations)
Note: There may also be symptoms of alcohol withdrawal.
Signs and tests
Examination of the nervous/muscular system may show damage to many nerve systems:
Abnormal eye movement
Decreased or abnormal reflexes
Fast pulse (heart rate)
Low blood pressure
Low body temperature
Muscle weakness and atrophy (loss of tissue mass)
Problems with walk (gait) and coordination
The person may appear poorly nourished. The following tests are used to check a person's nutrition level:
Blood or urine alcohol levels and liver enzymes may be high in people with a history of long-term alcohol abuse.
Other conditions that may cause thiamine deficiency include:
- AIDS
- Cancers that have spread throughout the body
- Extreme nausea and vomiting during pregnancy (hyperemesis gravidarum)
- Heart failure (when treated with long-term diuretic therapy)
- Long periods of intravenous (IV) therapy without receiving thiamine supplements
- Long-term dialysis
- Very high thyroid hormone levels (thyrotoxicosis)
A brain MRI may show changes in the tissue of the brain, but if Wernicke-Korsakoff syndrome is suspected, treatment should start immediately. Usually a brain MRI exam is not needed.
References
Brust JCM. Nutrition and alcohol-related neurologic disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 443.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Korsakoff psychosis; Alcoholic encephalopathy; Encephalopathy - alcoholic; Wernicke's disease
Treatment
The goals of treatment are to control symptoms as much as possible and to prevent the disorder from getting worse. Some people may need to stay in the hospital early in the condition to help control symptoms.
Monitoring and special care may be needed if the person is:
Comatose
Lethargic
Unconscious
Thiamine may be given by injection into a vein or a muscle, or by mouth. It may improve symptoms of:
Thiamine usually does not improve loss of memory and intellect that occur with Korsakoff psychosis.
Stopping alcohol use can prevent additional loss of brain function and damage to nerves. Eating a well-balanced, nourishing diet can help, but it is not a substitute for stopping alcohol use.
Support Groups
You can often ease the stress of illness by joining a support group where members share common experiences and problems. See alcoholism - support group.
Expectations (prognosis)
Without treatment, Wernicke-Korsakoff syndrome gets steadily worse and can be life threatening. With treatment, you can control symptoms (such as uncoordinated movement and vision difficulties), and slow or stop the disorder from getting worse.
Some symptoms -- especially the loss of memory and thinking skills -- may be permanent. Other disorders related to alcohol abuse may also occur.
Complications
- Alcohol withdrawal
- Difficulty with personal or social interaction
- Injury caused by falls
- Permanent alcoholic neuropathy
- Permanent loss of thinking skills
- Permanent loss of memory
- Shortened life span
In people at risk, Wernicke's encephalopathy may be caused by carbohydrate loading or glucose infusion. Always supplement with thiamine before glucose infusion to prevent this.
Calling your health care provider
Call your health care provider or go to the emergency room if you have symptoms of Wernicke-Korsakoff syndrome, or if you have been diagnosed with the condition and your symptoms get worse or return.
References
Brust JCM. Nutrition and alcohol-related neurologic disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 443.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Korsakoff psychosis; Alcoholic encephalopathy; Encephalopathy - alcoholic; Wernicke's disease
Prevention
Not drinking alcohol or drinking in moderation and getting enough nutrition reduce the risk of developing Wernicke-Korsakoff syndrome. If a heavy drinker will not quit, thiamine supplements and a good diet may reduce the chance of getting this condition, but do not eliminate the risk.
References
Brust JCM. Nutrition and alcohol-related neurologic disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 443.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.