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Wernicke-Korsakoff Syndrome (WKS)

Wernicke-Korsakoff Syndrome (WKS)

Sometimes referred to as alcoholic encephalopathy, alcohol induced encephalopathy, alcohol related encephalopathy (AJR), alcohol related brain damage, or "wet brain" is a neurological disorder caused by the lack of thiamine (vitamin B1) deficiency.

  • Wernicke encephalopathy (a type of delirium) being characterized by an acute/subacute confusional state and often reversible findings, if promptly and consistently treated.
  • While the findings of Korsakoff dementia, are persistent, chronic and irreversible.
  • Any condition resulting in a poor nutritional state places patients at risk. Vitamin B1 helps your brain turn sugar into energy.

Some argue the disorders to be separate but cormorbid, or overlap one another, like the Cleveland Clinic. “The disorder includes Wernicke encephalopathy and Korsakoff amnesic syndrome which are not different conditions but different stages of the same disease (Wernicke-Korsakoff syndrome)”, states WebbMD.
While korsakoff.org says, “Some believe that Wernicke’s Encephalopathy is the initial, onset phase and Korsakoff syndrome is the chronic, long-term state. Wernicke’s Encephalopathy often leads to Korsakoff Syndrome even after treatment. When not recognized or treated early, it can lead to permanent brain damage and even death.”

“In industrialized countries 90% of the cases of deficiency are associated with alcohol misuse (Thomson, 2000).

Failure to diagnose WE and institute adequate parenteral therapy results in death in 20% of patients; 75% will be left with permanent brain damage involving severe short-term memory loss [Korsakoff%E2%80%99s Psychosis (KP)]. Because of the close relationship between WE and KP, reference is often made to the Wernicke–Korsakoff Syndrome (WKS) as if it were a single entity.
Twenty five percent of patients with KP will be sufficiently affected to require long-term institutionalization. There has been a disturbing increase in KP in the UK over recent years” (…) (Ramayya and Jauhar, 1997; Cook et al., 1998).
THE NATURAL HISTORY AND PATHOPHYSIOLOGY OF WERNICKE’S ENCEPHALOPATHY AND KORSAKOFF’S PSYCHOSIS -ALLAN D. THOMSON AND E. JANE MARSHALL

According to the Alzheimer's Association, “Korsakoff syndrome is often — but not always — preceded by an episode of Wernicke encephalopathy”, which is an acute brain reaction to severe lack of thiamine.

Wernicke encephalopathy is a medical emergency that causes life-threatening brain disruption, confusion, staggering and stumbling, lack of coordination, and abnormal involuntary eye movements. It typically comes on suddenly.

Wernicke Symptoms

  • Drowsiness
  • Fainting
  • A faster heartbeat than normal
  • Low blood pressure when you stand up
  • A lack of energy
  • ⚠️ If you aren’t treated for Wernicke encephalopathy quickly, it can lead to Korsakoff syndrome ⚠️(irreversible brain damage⚠️ can even lead to death)⚠️

Korsakoff onset Symptoms

Symptoms of Korsakoff syndrome usually begin as the signs of Wernicke encephalopathy start to go away.

  • The telltale sign is the loss of short-term memory. That also makes it hard for you to learn anything new or make new memories.
  • Balance and movement issues. You might have leg tremors, and your walk might become slow and unsteady, with a wide stance and short steps. You may need help standing and getting around, and your arms and legs might feel weak.
  • Confusion. You may feel out of it and lose interest in what’s happening around you.
  • Vision problems. You may have double vision, your eyelids might droop, or your eyes may move around quickly.
  • Short-term Memory loss. You might talk to someone and seem like yourself. But a minute or two later, you won’t remember anything about it, not even who you spoke with.
  • You also may have problems with your heart and blood vessels that can lead to:
    • Drowsiness
    • Fainting
    • A faster heartbeat than normal
    • Low blood pressure when you stand up
    • A lack of energy
  • You may also have some long-term memory loss
    • The urge to make up stories without knowing it to fill in any gaps
    • Hallucinations
    • A hard time putting words into context
    • Trouble understanding or processing information

Causes and Risk Factors

In many cases, the lack of vitamin B1 is caused by heavy, long-term alcohol use.

  • Over time, alcohol affects how well your body absorbs, stores, and uses it.
  • It also can happen if you don’t get enough nutrients from your diet or if you have certain health problems.
  • Other potential causes include:
    • Some diseases that affect your whole body, like cancer, AIDS, or serious infections
    • Eating disorders, like anorexia
    • Serious kidney problems
    • Chemotherapy treatment for cancer
    • Some stomach conditions
    • Throwing up often and over a long period of time
    • Weight loss surgery, also known as gastric bypass
  • Men get Wernicke-Korsakoff syndrome a little more often than women, and it typically happens in people ages 45-65.
  • It's also more common in these groups who are more likely to abuse alcohol or not eat well.:

Complications

Korsakoff syndrome typically can’t be reversed. In serious cases, it can cause brain damage and lead to problems with memory and motor skills that don’t go away.

Outlook

Your recovery will depend mostly on how early you started treatment. If you catch and treat it early, you can make a full recovery, but it could take up to a year. Confusion and issues related to it are often the last symptoms to go away.

Survival of patients with an alcohol-related Wernicke-Korsakoff syndrome is poor; pursuing treatment of alcohol use disorder and early diagnosis of thiamine deficiency is a priority for improving clinical outcomes.


Science Direct Under-Recognized and Under-Treated
United Brain Association
korsakoffs.org - THE UPSTREET PROJECT - What is Wernicke-Korsakoff’s Syndrome?
NIH-NINDS
NIH-NIAAA
NIH-NLM-NCBI
WebMD

NORD
MedLine Plus - Medical Encyclopedia
Cleveland Clinic
Medscape
Alzheimer’s Association (US)
Alzheimer’s Society Canada
Alzheimer’s Society UK
Long Island Alzheimer's and Dementia Center
healthline
Family Caregiver Alliance
American Addiction Centers
Wikipedia
Medical News Today
Radiopaedia Wernicke encephalopathy
Last revised by Ammar Haouimi on 15 Dec 2023
CareLinx Wernicke-Korsakoff Syndrome (WKS): Causes, Risk Factors and Treatment – CareLinx Team; 6 Jul 2017 Image & info available

YouTube explanatory videos:
Osmosis from Elsevier‘s
Wernicke Korsakoff Syndrome (Year of the Zebra)
2-Minute Neuroscience