Wernicke-Korsakoff syndrome

• 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
    • Abnormal eye movements
    • Double vision
    • Eyelid drooping

  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:

  • Comatose
  • Lethargic
  • Unconscious

  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.