Wernicke-Korsakoff
syndrome
Alternative
names:
Korsakoff psychosis; alcoholic encephalopathy; encephalopathy, alcoholic;
Wernicke's disease
Definition:
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.
Prevention:
Minimal or moderate alcohol use and adequate nutrition reduce the risk
of developing Wernicke-Korsakoff syndrome.
Symptoms:
- vision changes
- double vision
- eye movements,
uncontrollable or twitching of the eyes
- eyelid drooping
- loss of muscle
coordination
- unsteady,
uncoordinated walking
- weakness
- movement,
dysfunctional
- hand tremor
- muscle contractions
- muscle atrophy
- facial paralysis
- sensation
changes
- decreased
sensation in the feet or hands, numbness
- abnormal
sensations, tingling
- thin, malnourished
appearance
- loss of hair
- dry skin
- swallowing
difficulty
- speech impairment
- hoarseness
or changing voice
- mood changes,
emotional changes, and behavior changes
- loss of memory,
can be profound
- confabulation
- decreased
intellect/cognitive skills
- decreased
problem solving
- loss of ability
to think abstractly
- autonomic
disturbances:
- orthostatic
dizziness
- constipation
- inability
to tolerate cold environment
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.
Treatment:
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.
Complications:
- permanent
loss of memory
- permanent
loss of cognitive/intellectual skills
- injury caused
by falls
- difficulty
with personal/social interaction
- alcohol withdrawal
state
- permanent
alcoholic neuropathy
- shortened
life span
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:
- delirium
or confusion.
- agitation.
- jumpiness
or nervousness
- insomnia
- hallucinations
- palpitations
- heart rate
that is faster than normal without an observable cause such as:
- increased
activity.
- pale skin
- profuse sweating
- muscle tremors
- seizures
- headache
- fever
- nausea/vomiting
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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