Wernicke-Korsakoff Syndrome

Snapshot

• A 65-year-old man with a history of chronic alcohol use presents to his primary care clinic. Two years ago, he was hospitalized for acute confusion, vision loss, and unsteady gait, which resolved with thiamine repletion. Since discharge, he has continued to drink alcohol heavily and has developed progressive forgetfulness. He cannot recall recent events. When asked questions, he responds confidently with incorrect answers. 

Introduction

• Occurs due to thiamine deficiency 
• Refers to two entities
  • Wernicke encephalopathy
    • acute
    • potentially reversible
    • involves mammillary bodies 
  • Korsakoff syndrome
    • chronic
    • irreversible 
• involves mammillary bodies, thalamic regions, and corpus callosum 

Presentation

• Clinical diagnosis that does not require imaging studies
• Wernicke’s encephalopathy
  • encephalopathy (disorientation, indifference, inattentiveness)
  • ophthalmoplegia
  • gait ataxia
• Korsakoff’s psychosis
  • memory loss (anterograde and retrograde)
  • confabulation 
• personality change

Treatment

• Thiamine must be administered with glucose to avoid precipitating the onset of Wernicke encephalopathy 
• Prescribe thiamine supplementation to patients at risk