Wernicke-Korsakoff syndrome is a Brain disorder involving loss of specific Brain functions caused by a thiamine deficiency.

Central Nervous System

Brain

One of the main reasons that alcoholism leads to thiamine deficiency has to do with the high-calorie nature of alcohol. A person with a large alcohol intake often, in essence, substitutes alcohol for other, more nutritive calorie sources. Food intake drops off considerably, and multiple vitamin deficiencies develop. Furthermore, it is believed that alcohol increases the body's requirements for B vitamins, at the same time interfering with the absorption of thiamine from the intestine and impairing the body's ability to store and use thiamine. Direct neurotoxic (poisonous damage to the nerves) effects of alcohol may also play some role. Thiamine is involved in a variety of reactions which provide energy to the neurons (nerve cells) of the Brain. When thiamine is unavailable, these reactions cannot be carried out, and the important end-products of the reactions are not produced. Furthermore, certain other substances begin to accumulate, and are thought to cause damage to the vulnerable neurons. The area of the Brain believed to be responsible for the symptoms of Korsakoff's syndrome is called the diencephalons, specifically the structures called the mamillary bodies and the thalamus.

Vision changes

Double vision Eye movement abnormalities Eyelid drooping

Loss of muscle coordination

Unsteady, uncoordinated walking Loss of memory, can be profound Inability to form new memories Confabulation (making up stories)

Hallucinations

Whenever someone has a possible diagnosis of alcoholism, and then has the sudden onset of memory difficulties, it is important to seriously consider the diagnosis of Korsakoff's syndrome. While there is no specific laboratory test to diagnose Korsakoff's syndrome in a patient, a careful exam of the individual's mental state should be rather revealing. Although the patient's ability to confabulate answers may be convincing, checking the patient's retention of factual information (asking, for example, for the name of the current president of the United States), along with the patient's ability to learn new information (repeating a series of numbers, or recalling the names of three objects, ten minutes after having been asked to memorize them) should point to the diagnosis. Certainly a patient known to have just begun recovery from Wernicke's syndrome, who then begins displaying memory difficulties, would be very likely to have developed Korsakoff's syndrome. A physical examination may also show signs of Wernicke's syndrome, such as peripheral neuropathy.

Treatment of both Korsakoff's and Wernicke's syndromes involves the immediate administration of thiamine. In fact, any individual who is hospitalized for any reason and who is suspected of being an alcoholic, should receive thiamine. The combined Wernicke-Korsakoff syndrome has actually been precipitated in alcoholic patients hospitalized for other medical illnesses, due to the administration of thiamine-free intravenous fluids (intravenous fluids are those fluids containing vital sugars and salts which are given to the patient through a needle inserted in a vein). Also, the vitamin therapy may be impaired by the feeding of carbohydrates prior to the giving of thiamine; since carbohydrates cannot be metabolized with thiamine.

Prevention depends on either maintaining a diet with a sufficient intake of thiamine, or supplementing an inadequate diet with vitamin preparations. Certainly, one of the most important forms of prevention involves treating the underlying alcohol addiction.

Fifteen to twenty percent of all patients hospitalized for Wernicke's syndrome will die of the disorder. Although the degree of ataxia nearly always improves with treatment, half of those who survive will continue to have some permanent difficulty walking. The paralysis of the Eye Muscles almost always resolves completely with thiamine treatment. Recovery from Wernicke's begins to occur rapidly after thiamine is given. Improvement in the symptoms of Korsakoff's syndrome, however, can take months and months of thiamine replacement. Furthermore, patients who develop Korsakoff's syndrome are almost universally memory-impaired for the rest of their lives. Even with thiamine treatment, the memory deficits tend to be irreversible, with less than 20% of patients even approaching recovery. The development of Korsakoff's syndrome often results in an individual requiring a supervised living situation.

Permanent loss of memory Permanent loss of cognitive skills Injury caused by falls Difficulty with personal or social interaction Alcohol withdrawal state Permanent alcoholic neuropathy Shortened life span