I was recently assigned a patient with a history of alcohol abuse who was admitted to the hospital with a diagnosis of Wernicke-Korsakoff syndrome (WKS). My knowledge of WKS was limited, so I prepared to care for this patient by conducting a mini knowledge brush-up. I want to share some of what I learned.
What is WKS?
Wernicke-Korsakoff syndrome, also known as "wet brain" or alcohol-related dementia is caused by thiamine deficiency. The syndrome is a combination of 2 separate conditions, Wernicke's encephalopathy, and Korsakoff syndrome. The most common cause of WKS is long-term heavy alcohol use. Alcoholics are often deficient in thiamine (B1) because of:
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Poor eating habits
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Frequent vomiting
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Inflamed stomach lining
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Decreased ability to absorb vitamins in food
But WKS can also be caused by other conditions that lower thiamine levels. These causes may include:
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Bariatric surgery
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Colon surgery
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Gastric cancer
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Eating disorders
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Chronic vomiting
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Stomach disorders
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Kidney disorders
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Intestinal disorders
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Malabsorption disorders
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Chronic infection
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Metastatic cancer
Incidence
WKS occurs in 1-2 percent of the U.S. population. However, the percentage may be higher because WKS is not always detected by healthcare providers. Males carry a slightly higher risk, and the condition occurs evenly in people between the ages of 30-70.
Wernicke's Encephalopathy
Wernicke's encephalopathy (WE) is a neuropsychiatric disorder and usually occurs first in WKS. Symptoms can present suddenly, sometimes progressing in just hours. Wernicke's requires immediate medical intervention, but the symptoms are frequently missed or misdiagnosed. It's often assumed the patient's behavior and physical symptoms are simply related to alcohol intoxication. Symptoms of WE may include:
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Confusion about place, time
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Drowsiness
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Loss of muscle coordination
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Poor balance or difficulty walking
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Leg numbness or tingling
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Vision changes, such as double vision, eyelid drooping
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Involuntary eye movements or paralysis of eye muscles
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Memory gaps and poor memory recall
If treatment is not given in time, irreversible brain damage or even death may occur.
Diagnosis
A clinical diagnosis of WE in alcoholics requires two of the following four signs to be present:
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Dietary deficiencies
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Eye/visual problems
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Cerebellar dysfunction, such as
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Vertigo
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Balance problems
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Uncoordinated movements
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Problems with speech
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Altered mental status
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Mild memory impairment
Diagnostic tests, such as labs and radiographic studies, are important in ruling out other potential causes for the patient's symptoms.
Treatment
The goal of treatment is to quickly correct the B1 deficiency with intravenous or intramuscular administration of thiamine.
WE Prognosis
If left untreated, Wernicke's encephalopathy can lead to permanent brain damage and death. However, the condition may be reversed with early diagnosis and treatment. Once thiamine is administered, some symptoms begin to improve within hours. Memory impairments are slower to improve and often do not return the patient's baseline.
Around 80 to 90 percent of people who develop Wernicke's encephalopathy go on to develop Korsakoff's psychosis.
Korsakoff Syndrome
Korsakoff syndrome is the chronic stage of WKS and can be long-lasting. Nerve cells in the brain and spinal cord are damaged, resulting in severe cognitive and memory deficits and difficulty performing day-to-day tasks. Other symptoms include:
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Amnesia
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Tremor
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Coma
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Disorientation
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Vision problems
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Personality changes
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Confabulation
Research has suggested around 25% of patients with Korsakoff syndrome recover fully, about 50% make a partial recovery, and 25% experience no change in their condition.
Wernicke-Korsakoff Syndrome
As in WE, diagnostic tests are important in ruling out other potential causes for an accurate WKS diagnosis.
The following diagnostics are used to diagnose WKS:
Blood tests for:
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Thiamine levels
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Liver function
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Kidney function
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Brain imaging
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Eye exam
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Mental health exam
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Tests to assess the brain and nervous system
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Gait and ambulation tests
Treatment
WKS usually requires hospitalization, administration of IV thiamine and management of symptoms. Thiamine therapy also treats some common symptoms, such as vision, eye problems and confusion/disorientation.
Prognosis
All of the symptoms of WKS are not always reversible but the progression of the syndrome can be prevented if thiamine levels remain stable. This requires abstinence from alcohol, a balanced diet and treatment of other underlying medical problems. Some patients will require physical and/or occupational therapy to help them become as independent as possible in their daily life. The condition is fatal if left untreated.
What conditions or topics do you need to brush up on your knowledge?
References
Wernicke-Korsakoff Syndrome Information Page
What is Wernicke-Korsakoff Syndrome?
Wernicke-Korsakoff Syndrome
CDC Alcohol Fact Sheets- Alcohol Use and Your Health
