Wernicke-Korsakoff syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 3, 2016
StartDiseasesWernicke-Korsakoff syndrome

Wernicke-Korsakoff syndrome is a syndrome that can cause life-threatening brain damage and mental health issues. The primary cause for the syndrome is a deficiency of vitamin B1 or thiamine (beriberi). This syndrome can result in permanent brain damage. Alcoholism is the predominant – but not the only – cause of this syndrome. Physicians identify most Wernicke-Korsakoff patients during alcoholism treatment. Some studies have shown that the mortality rate is 40 percent among alcoholic patients.

Contents

Definition & Facts

Wernicke's encephalopathy, a condition that alters brain structure, and Korsakoff's syndrome, a memory loss syndrome, are two, almost simultaneously occurring conditions, that afflict patients. The sickness befalls individuals who lack vitamin B1, most often due to alcoholism but also because of malnourishment.

The condition can also occur in individuals with chronic illnesses such as cancer and AIDS or following weight loss surgeries (also known as bariatric surgery).

Researchers are unsure of all the exact mechanisms of how Wernicke's encephalopathy damages the brain, but do know that the thiamine deficiency affects the thalamus and hypothalamus brain sections. Korsakoff psychosis typically afflicts individuals once Wernicke encephalopathy subsides, where psychosis takes root after Wernicke's encephalopathy permanently damages the individual's memory centers.

Symptoms & Complaints

Individuals who develop Wernicke encephalopathy can suffer consistent mental abnormalities, or show no effects at all. Other individuals may hold lucid conversations, and then suddenly forget the entire dialogue. The most severe cases cause confusion and diminished mental facilities in the afflicted, which can lead to unconsciousness and sometimes death.

Patients can also lose muscle control resulting in leg tremors (ataxia) and suffer vision disorders such as rapid eye movement (nystagmus), double vision (diplopia), and eyelid sagging (ptosis).

Patients who develop the syndrome due to drinking may also undergo alcohol withdrawal. Individuals can also suffer severe memory loss and lose the ability to form new memories.

Some patients may begin to make up nonsensical stories and suffer from hallucinations, a phenomenon which researchers do not fully understand. A diminished ability to absorb vitamin B1 poses an increased threat for individuals that must undergo kidney dialysis or suffer from AIDS.

The syndrome can result in bleeding in the affected brain areas (brain hemorrhage) and lead to the associated physical afflictions.

Causes

The root cause of the syndrome is a vitamin deficiency that can result from any eating disorder like anorexia nervosa or bulimia nervosa. Liquor interferes with the body’s ability to deliver nutrients and the liver's capacity to store thiamine. The most common cause of this syndrome is alcoholism, which can accelerate progress once the sickness appears, although the illness does affect some individuals who do not consume alcoholic beverages.

This condition can also occur within two weeks after weight loss surgery. These individuals often recover in three to six months if physicians identify the condition immediately. Those who suffer from other sicknesses - such as anorexia, schizophrenia and stomach cancer – can also fall ill to Wernicke-Korsakoff syndrome.

Infants can develop the syndrome by consuming vitamin B1 deficient infant formula or breast milk from a mother who has a thiamine deficiency. Among pregnant women with the syndrome, the infant mortality rate is almost 50 percent.

Patients with inflammatory bowel syndrome are also at a higher risk for developing Wernicke-Korsakoff syndrome. Intestinal obstructions, such as abscesses, can also cause the syndrome. In rare cases, plastic surgery patients develop the syndrome.

Diagnosis & Tests

There is no test to identify Wernicke-Korsakoff syndrome. Physicians often have difficulty identifying the syndrome, because alcohol abuse symptoms typically mask Wernicke-Korsakoff indicators. These patients often emerge during emergency room visits. Because of this, physicians normally ask patients that exhibit mental deficiencies, such as memory loss, about their drinking habits.

Individuals who suffer from the syndrome typically undergo psychiatric evaluation as a precaution. Those who develop the syndrome due to alcoholism may also need electrolyte replacement.

Physicians are watchful for this condition among chronic drinkers, and recommend that any individual who exhibits symptoms begin a regimen of intravenous vitamin B1 therapy immediately. Some physicians recommend that all heavy drinkers obtain vitamin B1 prescriptions from their care providers.

Treatment & Therapy

To begin treatment, physicians give most patients vitamin B1 intravenously for the first week, proceeded by a regular prescription of the equivalent in pill form, because the vitamin does not digest easily. For individuals that refuse to halt alcohol consumption, the necessary dosage is much higher. Medical personnel must observe each individual as they take the supplement in case of a negative reaction.

Wernicke-Korsakoff patients must continue to receive vitamin B1 monitoring to prevent the syndrome’s recurrence. They can stop taking the vitamin supplement once symptoms subside, unless they opt to continue drinking.

Physicians also administer glucose to severely malnourished Wernicke-Korsakoff syndrome patients, which takes precedent over administering vitamin B1 for those with extremely low blood sugar levels (hypoglycemia).

Treatment also necessarily involves treatment for any underlying mental or physical disorders such as alcoholism and eating disorders. Group therapy, counseling, psychotherapy, and psychiatric medications are all possible forms of treatment for mental disorders.

For those suffering from permanent brain damage, they may need to be institutionalized or undergo speech therapy, physical therapy, and occupational therapy to regain certain skills or improve their quality of life.

Prevention & Prophylaxis

A preventative measure is to provide vitamin B complex prescriptions to individuals who display alcoholism. Though nominally preventative, there is relatively little related cost, and clinical staff members can observe and assist those that react negatively to the vitamin.

Due to the high death rate associated with Wernicke-Korsakoff syndrome, physicians want to develop preventative practices to curtail the disorder’s effects, and at the same time save resources while identifying potential Wernicke-Korsakoff syndrome candidates.

Most individuals who develop Wernicke-Korsakoff syndrome suffer lifelong health infirmities. The syndrome results from a vitamin B1 deficiency, most often brought on by alcoholism or malnutrition. When physicians identify the sickness at its onset, 10 percent of the patients experience a full recovery, while the other suffer life changing consequences ranging from brain damage to death.

Proper nutrition and regular health monitoring are the only current tools to manage the syndrome until researchers discover a better solution.