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Wernicke-Korsakoff syndrome (reviewed)
Terms in this set (15)
Spectrum of disease resulting from thiamine deficiency, usually related to EtOH abuse.
Triad of Wernicke's encephalopathy
Mental confusion, ataxia and ophthalmoplegia.
Later manifestation of Korsakoff syndrome, where Wernicke's encephalopathy has not been adequately treated.
Epidemiology of Wernicke-Korsakoff syndrome
10-24% of dementias contributed to be alcohol-related brain damage.
Highest prevalence in those aged 50-60 yo.
Pathogenesis of Wernicke-Korsakoff syndrome
Chronic alcohol consumption causes thiamine deficiency due to inadequate nutritional intake, decreased absorption from the GI tract and impaired thiamine utilisation in the cells.
Thiamine (B1) is a cofactor required by 3 enzymes pathways for carbohydrate metabolism.
When to suspect Wernicke-Korsakoff syndrome
History of EtOH abuse.
Confusion, N+V, fatigue, weakness or apathy.
Unexplained hypotension or hypothermia.
Presentation of Wernicke-Korsakoff syndrome
Vision changes: double vision, eye movement abnormalities, eyelid drooping.
Loss of muscle co-ordination: unsteady, uncoordinated walking.
Loss of memory with inability to form new memories.
Usually mentally alert with vocabulary, comprehension, motor skills, social habits and naming ability maintained.
Examination findings in Wernicke-Korsakoff syndrome
Signs of polyneuropathy; abnormal reflexes or reduced reflexes; gait and co-ordination abnormality; weak/atrophic muscles; eye movement abnormalities; low BP and T; high pulse; appear cachectic.
Cognitive features of Wernicke-Korsakoff syndrome
Confabulation: falsification of memory in clear consciousness.
Anterograde amnesia: loss of memory after the onset of the disorder inability to learn or repeat. Disorientated in time and place.
Retrograde amnesia: but distant event may be preserved (telescoping- thinks it happened recently).
Diagnosis of Wernicke's Encephalopathy
Altered mental state or mild memory impairment.
Investigation of Wernicke-Korsakoff syndrome
FBC (MCV), U + E, LFTs, glucose, ABG, cholesterol, serum thiamine; pyruvate; red cell transketolase; LP to exclude confocal CNS infections.
Alcohol levels elevated.
Diseases associated with Wernicke-Korsakoff syndrome
Peripheral neuropathy, paraesthesia, malnutrition, liver disease, delirium tremens (around 10%), beriberi (about 5%).
Management of Wernicke-Korsakoff syndrome
Medical emergency if acute.
IM or IV Pabrinex.
Thiamine orally plus vitamin B complex or multivitamins (indefinitely)
Be aware of allergic reaction.
If hypoglycaemic: thiamine first. As glucose would make deficiency worse.
Wernicke-Korsakoff syndrome prevention
Offer oral thiamine to harmful or dependent drinkers if:
malnourished or decompensated liver disease.
Complications of Wernicke-Korsakoff syndrome
Develop Korsakoff's syndrome.
20% recover completely.
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