Wernicke-Korsakoff syndrome (patient information)

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Wernicke-Korsakoff syndrome

Overview

What are the symptoms?

What are the causes?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Wernicke-Korsakoff syndrome?

Prevention of Wernicke-Korsakoff syndrome

What to expect (Outlook/Prognosis)?

Possible complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Overview

Wernicke-Korsakoff syndrome is a brain disorder due to thiamine deficiency.

What are the symptoms of Wernicke-Korsakoff syndrome?

Symptoms of Wernicke's encephalopathy:

Symptoms of Korsakoff syndrome:

Note: There may also be symptoms of alcohol withdrawal.

What causes Wernicke-Korsakoff syndrome?

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.

When to seek urgent medical care?

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.

Diagnosis

Examination of the nervous/muscular system may show damage to many nerve systems:

The person may appear poorly nourished. The following tests are used to check a person's nutrition level:

  • Serum albumin (relates to person's general nutrition)
  • Serum vitamin B1 levels
  • Transketolase activity in red blood cells (reduced in people with thiamine deficiency)

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.

Treatment options

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:

Thiamine may be given by injection into a vein or a muscle, or by mouth. It may improve symptoms of:

  • Confusion or delirium
  • Difficulties with vision and eye movement
  • Lack of muscle coordination

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.

Where to find medical care for Wernicke-Korsakoff syndrome?

Directions to Hospitals Treating Wernicke-Korsakoff syndrome

Prevention of Wernicke-Korsakoff syndrome

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.

What to expect (Outlook/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.

Possible 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.

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000771.htm

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