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Wernicke-Korsakoff syndrome is a brain disorder due toÊthiamine deficiency.
Causes
WernickeÕs 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 withÊalcoholism. 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 WernickeÕs symptoms go away. WernickeÕs 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.
Symptoms
Symptoms of WernickeÕs encephalopathy:
- Confusion
- Loss of muscle coordination(ataxia)
- Leg tremor
- 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 arenÕt really there (hallucinations)
Note: There may also be symptoms ofÊalcohol withdrawal.
Exams and Tests
Examination of the nervous/muscular system may show damage to many nerve systems:
- Abnormal eye movement
- Decreased or abnormal reflexes
- FastÊpulse (heart rate)
- LowÊblood pressure
- Low bodyÊtemperature
- 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 personÕs nutrition level:
- Serum albumin (relates to personÕs 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-termÊalcohol 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 brainÊMRI 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
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:
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 theÊstress of illness by joining aÊsupport group where members share common experiences and problems. SeeÊalcoholism Ð support group.
Outlook (Prognosis)
Without treatment, Wernicke-Korsakoff syndrome gets steadily worse and can be life threatening. With treatment, you can control symptoms (such asÊuncoordinated movement andÊvision difficulties), and slow or stop the disorder from getting worse.
Some symptoms Ñ especially the loss of memory and thinking skills Ñ 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
- PermanentÊalcoholic neuropathy
- Permanent loss of thinking skills
- Permanent loss of memory
- Shortened life span
In people at risk, WernickeÕs encephalopathy may be caused by carbohydrate loading or glucose infusion. Always supplement with thiamine before glucose infusion to prevent this.
When to Contact a Medical Professional
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.
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.
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