From the Guidelines
Wernicke-Korsakoff syndrome is characterized by neurological symptoms, including mental changes such as apathy, decrease in short-term memory, confusion, and irritability, as well as cognitive deficits, which can progress to severe memory problems if left untreated. The syndrome presents with two distinct but related conditions, Wernicke's encephalopathy and Korsakoff syndrome, often occurring together due to thiamine (vitamin B1) deficiency, typically associated with chronic alcohol abuse 1. Signs and symptoms of Wernicke's encephalopathy include:
- Confusion
- Ataxia (unsteady gait)
- Abnormal eye movements (nystagmus, double vision, or paralysis of eye muscles)
- Hypothermia
- Low blood pressure
- Tachycardia If untreated, this acute phase progresses to Korsakoff syndrome, characterized by:
- Severe memory problems, particularly difficulty forming new memories (anterograde amnesia) and gaps in existing memories (retrograde amnesia)
- Confabulation (making up stories) to fill memory gaps
- Lack of insight into their condition
- Apathy with personality changes As noted in the espen micronutrient guideline, early suspicion and recognition of thiamine deficiency are needed to enable immediate initiation of therapy, as thiamine reserves are depleted as early as 20 days of inadequate oral intake 1. Treatment requires immediate administration of thiamine to prevent permanent neurological damage.
From the Research
Signs and Symptoms of Wernicke-Korsakoff Syndrome
- The clinical presentation of thiamine deficiency includes loss of appetite, dizziness, tachycardia, and urinary bladder retention 2
- Confusion or delirium is part of the classic triad of Wernicke encephalopathy 2
- Severe concomitant infections including sepsis of unknown origin are common during the Wernicke phase 2
- The classical triad of clinical symptoms (abnormal mental state, ataxia, and ophthalmoplegia) is found in only 16-33% of patients on initial examination 3
- Wernicke's encephalopathy (WE) typically manifests as confusion, ophthalmoplegia, nystagmus, and gait ataxia (Wernicke's triad), although they may not consistently occur together 4
- Korsakoff syndrome is a chronic amnesia resulting from unrecognized or undertreated Wernicke encephalopathy and is caused by thiamine (vitamin B1) deficiency 2
- Cognitive impairment, such as memory formation, is a prominent symptom of Korsakoff syndrome 5, 6
Risk Factors and Causes
- Alcohol addiction is a common cause of Wernicke encephalopathy, but it can also occur in other conditions, such as bariatric surgery, hyperemesis gravidarum, and anorexia nervosa 2, 3, 4
- Non-alcoholic patients are also affected by Wernicke encephalopathy and may present symptoms and radiological imaging findings different from patients with alcoholism 3
- Predisposing factors, such as malnutrition and thiamine deficiency, can contribute to the development of Wernicke-Korsakoff syndrome 5, 2, 6