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Wernicke-Korsakoff Syndrome

What Is Wernicke–Korsakoff Syndrome?

Wernicke-Korsakoff syndrome (WKS) is a type of brain disorder caused by a lack of vitamin B-1. The syndrome is actually two separate conditions that can occur at the same time. Usually, people get the symptoms of Wernicke’s encephalopathy first.

Also called Wernicke’s disease, people with Wernicke’s encephalopathy have bleeding in the lower sections of the brain, including the thalamus and hypothalamus. These areas of the brain control the nervous and endocrine systems. The bleeding causes brain damage that presents symptoms involving your vision, coordination, and balance.

The signs of Korsakoff psychosis tend to follow as the Wernicke’s symptoms decrease. If Wernicke’s disease is treated quickly and effectively, Korsakoff syndrome may not develop. Korsakoff psychosis is the result of chronic brain damage. Korsakoff syndrome affects the areas of your brain that control memory.

Alcoholism, or chronic alcohol abuse, is the most common cause of WKS. WKS can also be linked to diet deficiencies or other medical conditions that impair vitamin B-1 absorption. Vitamin B-1 is also called thiamine.

To diagnose WKS, your doctor will look for clinical signs that point to a vitamin B-1 deficiency. This can include blood tests that measure thiamine levels and your general nutritional health, as well as tests to check your liver function.

Chronic alcoholism can damage your liver, elevating your liver enzymes. Diagnosis includes a physical examination to assess your:

  • heart rate
  • eye movements
  • reflexes
  • blood pressure
  • body temperature

After diagnosis, your doctor will most likely give you vitamin B-1 intravenously, or through your vein. Fast treatment may reverse many of the neurological symptoms of WKS.

The key to recovery is maintaining adequate vitamin B-1 levels, which means refraining from alcohol abuse if you have WKS. You should also eat a balanced diet.

Risk Factors for WKS

Risk factors for WKS are related to your diet and lifestyle.

The major risk factors for developing WKS are malnourishment and chronic alcoholism. Other risk factors for WKS include:

  • being unable to afford medical care and proper food
  • undergoing kidney dialysis, which reduces vitamin B-1 absorption
  • AIDS, which makes you more likely to develop conditions that lead to vitamin B-1 deficiency

Causes of WKS

The number one cause of WKS is alcoholism.

The less common causes of WKS are conditions that limit nutritional absorption. Eating and nutrient absorption can be restricted by:

  • gastric bypass surgery, which makes it difficult to meet nutritional needs due to limited food portions
  • colon cancer, which can cause pain that causes you to put off eating
  • eating disorders

Alcoholism is the number one cause of WKS because people who are alcoholics generally have a poor diet. Alcohol also prevents vitamin B-1 absorption and storage.

Symptoms of WKS

Lesions on the brain cause Wernicke’s disease (WD). These lesions are the result of a vitamin B-1 deficiency.

Prominent symptoms of WD are:

  • double vision
  • a drooping upper eyelid
  • up-and-down or side-to-side eye movements
  • loss of muscle coordination
  • a confused mental state

WD can later develop into Korsakoff’s syndrome. People who have WKS have a variety of issues relating to memory. You may suffer from memory loss or be unable to form new memories.

You may also have the following symptoms if you have WKS:

  • amnesia for events that happen after the onset of the disorder
  • difficulty understanding the meaning of information
  • difficulty putting words into context
  • hallucinations
  • exaggerated storytelling, or confabulation

Diagnosing WKS

Diagnosing WKS isn’t always easy.

An individual with WKS is often mentally confused. This can make communication with the doctor difficult. Your doctor may overlook the possibility of a physical disorder if you’re confused.

Your doctor may first check for signs of alcoholism. They may check your blood alcohol levels. Sometimes, a doctor will take a liver function test to check for liver damage. Liver damage is a common sign of alcoholism.

Your doctor may also order nutritional tests to make sure you aren’t malnourished. Nutritional tests may include the following:

  • A serum albumin test measures the levels of albumin, which is a protein in the blood. Low levels of albumin may signal nutritional deficiencies as well as kidney or liver problems.
  • A serum vitamin B-1 test is a blood test to check vitamin B-1 levels in the blood. Enzyme activity in the red blood cells can be tested. Low enzyme activity in the red blood cells signals a vitamin B-1 deficiency.

You may also need imaging tests. These tests can help your doctor find any damage that’s characteristic of WKS.

Diagnostic imaging tests for WKS include:

  • an electrocardiogram (EKG) before and after giving vitamin B-1, which can help your doctor find abnormalities
  • a CT scan to check for brain lesions related to WD
  • an MRI scan to look for brain changes related to WD

Your doctor may also use neuropsychological test to determine the severity of any mental deficiencies.

Treatment for WKS

WKS treatment should begin immediately. Prompt treatment may delay or stop disease progression. Treatments are also able to reverse non-permanent brain abnormalities.

Treatment may first involve hospitalization. At the hospital, you’ll be monitored to ensure your digestive system is absorbing food properly.

The treatment for WKS may include:

  • vitamin B-1 given through an IV in the arm or hand
  • vitamin B-1 given by mouth
  • a balanced diet to keep vitamin B-1 levels up
  • treatment for alcoholism

In a small number of cases, treatment of vitamin B-1 deficiency produces a negative reaction. This is more common in alcoholics.

Negative reactions to receiving vitamin B-1 may vary. Reactions may include alcohol withdrawal symptoms like insomnia, sweating, or mood swings. You may also experience hallucinations, confusion, or agitation.

Outlook for WKS

The outlook for WKS is based on how far the disease has advanced.

Receiving early treatment before irreversible damage has occurred dramatically improves your outlook.

Mortality rates are high if WKS is left untreated. Most deaths are the result of a lung infection, blood poisoning (septicemia), or irreversible brain damage.

Those who receive fast treatment can see progress in:

  • eye problems
  • muscle coordination
  • confusion

You must abstain from alcohol to continue recovery of memory and mental function.

You also need to eat a balanced diet to prevent future vitamin B-1 deficiencies. Foods rich in vitamin B-1 include:

  • lean pork
  • rice
  • peas
  • whole wheat bread
  • spinach
  • oranges
  • milk

Prevention of WKS

You can prevent WKS by avoiding alcohol and eating a balanced diet rich in vitamin B-1.

Content licensed from:

Written by: Lydia Krause and Erica Roth
Medically reviewed on: Dec 10, 2015: Steven Kim, MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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