From the Guidelines
Wernicke-Korsakoff psychosis should be treated with high-dose parenteral thiamine supplementation as soon as possible, as it is a medical emergency that can lead to permanent brain damage if left untreated. This condition is a serious neurological disorder caused by thiamine (vitamin B1) deficiency, most commonly seen in people with chronic alcoholism 1. It consists of two phases: Wernicke's encephalopathy, an acute emergency characterized by confusion, abnormal eye movements, and unsteady gait; followed by Korsakoff psychosis, a chronic condition marked by severe memory problems, confabulation (making up stories), and an inability to form new memories.
Key Considerations
- Thiamine administration should typically be 500mg intravenously three times daily for 2-3 days, followed by 250mg daily for 3-5 days, then oral thiamine 100mg daily indefinitely 1.
- Treatment must begin before glucose administration in at-risk patients, as glucose can worsen thiamine deficiency 1.
- While thiamine replacement can improve the acute symptoms of Wernicke's encephalopathy, the memory problems of Korsakoff psychosis often persist permanently.
- Complete alcohol abstinence is essential for preventing further brain damage 1.
- The condition occurs because thiamine is crucial for brain energy metabolism, and its deficiency leads to damage in specific brain regions involved in memory formation and coordination.
Additional Recommendations
- Patients with both alcohol- and non-alcohol-related cirrhosis are prone to deficiencies in water-soluble vitamins, particularly thiamine, and should be treated accordingly 1.
- A course of oral multivitamin supplementation could be justified in patients with decompensated liver disease 1.
- Malnutrition is often underdiagnosed in patients with hepatic encephalopathy, and nutritional options are relevant 1.
From the Research
Definition and Causes of Wernicke-Korsakoff Psychosis
- Wernicke-Korsakoff syndrome is a potentially debilitating and fatal condition caused by thiamine (vitamin B1) deficiency in the brain 2.
- The syndrome is commonly associated with individuals who misuse alcohol, but there are many other predisposing factors and causes, including non-alcoholic factors 2, 3.
- Thiamine deficiency represents a common cause of both Wernicke's encephalopathy and Korsakoff's psychosis, which are severe unfavorable forms of brain damage with poor prognosis 3.
Clinical Symptoms and Diagnosis
- Clinical symptoms of Wernicke-Korsakoff syndrome are often ambiguous and may include abnormal mental state, ataxia, and ophthalmoplegia, although the classical triad is found in only 16-33% of patients on initial examination 4.
- The syndrome is underdiagnosed because of the inconsistent clinical presentation and overlapping of symptoms with other neurological conditions 5.
- Post-mortem examinations show that the syndrome is underdiagnosed and probably undertreated 6.
Treatment and Management
- The basic approach to the treatment of Wernicke-Korsakoff syndrome is long-term parenteral administration of thiamine, often in high doses 3.
- All patients with a history of alcohol abuse should be treated with high dosage IV thiamine for an extended period of time, albeit further research is needed 6.
- Early diagnosis and treatment are crucial to prevent the development of the amnestic state associated with Korsakoff psychosis in genetically predisposed individuals 5.