Health Encyclopedia

Wernicke-Korsakoff syndrome

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 believed to be two stages of the same condition.

Wernicke's encephalopathy is caused by damaging changes in the brain, usually due to a lack of vitamin B1 (thiamine).

A lack of vitamin B1 is common in people with alcoholism. Heavy alcohol use affects the breakdown of thiamine in the body. Even if someone who drinks alcohol heavily follows a well-balanced diet, most of the thiamine is not absorbed.

Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke's symptoms go away. Korsakoff psychosis involves damage to areas of the brain involved with memory.

Symptoms

Inability to form new memories
Loss of memory, can be severe
Loss of muscle coordination (ataxia)
- Unsteady, uncoordinated walking
Making up stories (confabulation)
Seeing or hearing things that aren't really there (hallucinations)
Vision changes

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:

Decreased or abnormal reflexes
Problems with walk (gait) and coordination
Muscle weakness and atrophy (loss of tissue mass)
Abnormal eye movement
Low blood pressure
Low body temperature
Fast pulse (heart rate)

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

Pyruvate
Serum B1 levels
Transketolase activity

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 in rare cases shows changes in the tissue of the brain.

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:

Thiamine (vitamin B1) 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 does not usually improve loss of memory and intellect that occur with Korsakoff psychosis.

Stopping alcohol use can prevent loss of brain function and damage to nerves. Eat a well-balanced, nourishing diet.

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 if you have symptoms of Wernicke-Korsakoff syndrome, or if you have been diagnosed with the condition and your symptoms get worse or return.

Also call if new symptoms develop, especially 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:

Agitation
Delirium or confusion
Fast heart rate
Hallucinations
Insomnia
Jumpiness or nervousness
Palpitations

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 help prevent this condition, but not if damage has already occurred.

Review Date:2/13/2008
Reviewed By:Luc Jasmin, MD, PhD, Departments of Anatomy & Neurological Surgery, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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