Wernicke-Korsakoff Syndrome: Symptoms, Causes and Treatment

Overview

Lack of vitamin B1 and alcohol misuse results in Wernicke-Korsakoff syndrome. Vitamin B1 deficiency may result from malnutrition, alcohol misuse, prolonged vomiting, eating disorders, or side effects of chemotherapy. It is a neurodegenerative condition which damages the brain’s thalamus and hypothalamus. Experts believe that Wernicke’s encephalopathy and Korsakoff syndrome are different stages of the same disease. The condition is incurable, but several treatment options help manage the symptoms. 

The blog  explores Wernicke-Korsakoff syndrome, its symptoms, causes, diagnosis, and various treatment options. 

What is Wernicke-Korsakoff syndrome?

As mentioned above, Wernicke-Korsakoff syndrome is a  neurodegenerative disease. Wernicke encephalopathy is a disorder due to vitamin B1 deficiency leading to damage to the brain’s thalamus and hypothalamus. On the other hand, Korsakoff’s syndrome is also linked to a lack of vitamin B1 and alcohol misuse. The disorder is known to cause damage to the brain’s and spinal cord’s nerve and supporting cells, including the region of the brain which is responsible for memory. 

Vitamin B1 is responsible for helping the brain convert sugar into energy. However, when the brain and nervous system get inadequate vitamin B1, they fail to perform efficiently. 

While the onset of Wernicke’s encephalopathy is sudden and requires immediate medical attention, Korsakoff syndrome progressively develops to cause harm to the part of the brain responsible for memory. Some experts refuse to believe that Wernicke’s encephalopathy and Korsakoff’s syndrome are separate but related disorders or their symptoms are a part of a single disorder. However, several other researchers consider Wernicke’s encephalopathy as the initial stage of the disease and Korsakoff syndrome as the progression of the disorder from chronic to irreversible .

What are the symptoms of Wernicke-korsakoff syndrome?

Typically, individuals first develop Wernicke’s encephalopathy, gradually leading to Korsakoff syndrome. The following are the symptoms of Wernicke’s encephalopathy:

Prominent symptoms of WE are:

• double vision
• a drooping upper eyelid, also known as ptosis
• up-and-down or side-to-side eye movements
• loss of muscle coordination, or ataxia, which may interfere with walking
• a confused mental state, which frequently leads to combativeness or violent behavior

WD can later develop into Korsakoff’s syndrome. People who have WKS have a variety of issues relating to memory. You may experience 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

The disorder may also affect the heart and blood vessels resulting in the following:

• Drowsiness
• Fainting spells
• Rapid heartbeat
• Decreased blood pressure while standing
• Lack of energy

The patients also suffer from various eye issues, such as:

• Abnormal eye movement, known as nystagmus
• Double vision
• Drooping eyelid
• Weakness and paralysis in the eye muscle

If untreated, it may lead to Korsakoff syndrome. Typically, it begins as Wernicke’s encephalopathy, and the patient may recover. However, the unmistakable sign of Korsakoff syndrome is short-term memory issues . Here, patients find it challenging to learn something new or make new memories. For instance, the patient may interact with others. But after a few minutes may not remember the conversation or the person they spoke to. Other symptoms may include the following:

• Long-term memory loss
• Hallucinations, particularly with those with alcohol withdrawal and disorientation
• Difficulty understanding or processing information or amnesia
• The desire to unintentionally make up stories to fill in the memory gaps, known as confabulation
• Difficulty relating words to any context 
• Changes in behaviour, such as agitation or anger
• Change in gait
• Distracted or lack of focus

Sometimes, the symptoms may not improve even after treatment. Also, in severe cases, patients may slip into a coma.

Who is at risk of developing Wernicke-Korsakoff syndrome?

Chronic alcoholics are most likely to develop Wernicke-Korsakoff syndrome as constant alcohol use irritates the stomach and digestive tract, interfering with the body’s ability to absorb vitamins efficiently. It is estimated that nearly 80% of alcoholics lack vitamin B1. 

People unable to absorb nutrition from food due to other health conditions can also develop Wernicke-Korsakoff syndrome. It can also occur after bariatric surgery, surgery for weight loss, and as a side effect of chemotherapy. Other risk factors include the following:

• Issues with the bowel or stomach, such as inflammatory bowel disease or stomach disease
• Advanced stages of cancer 
• Exceptionally high thyroid hormone levels
• Certain genetic mutations
• Heart failure which is being treated with diuretic therapy for an extended period
• HIV/AIDS leads to lower vitamin B1
• Kidney failure with a long-term dialysis treatment that reduces the body’s ability to absorb vitamin B1
• Improper medical care or malnutrition 
• Extreme nausea and vomiting during pregnancy

Men are more susceptible than women. Typically, it can develop in people between the age group of 45-65 and is often found among:

• Homeless people 
• Older adults living independently
• People with disorders of Mental health 

What are the causes of Wernicke-Korsakoff syndrome?

The foremost cause of Wernicke-Korsakoff syndrome is alcohol, leading to nutrition malabsorption and vitamin B1 deficiency. Other causes are as follows:

• Heath disorders that affect the entire body, such as cancer, AIDS, and serious infections
• Eating disorders, including anorexia
• Kidney issues 
• Chemotherapy
• Gastric bypass surgery
• Vomiting for a prolonged time during pregnancy
• Poor diet
• Head injury

When to seek medical attention?

If a person notices the symptoms of Wernicke-Korsakoff syndrome or notices new signs, contacting a healthcare provider is crucial. 

Request an appointment at Apollo Hospitals 

How is Wernicke-korsakoff syndrome diagnosed?

After the physical exam and detailed health history, the doctor recommends the following tests:

• Blood tests to check the liver and kidneys function, and the thiamine levels
• Imaging scans of the brain to check for tumours or stroke
• Eye examination that checks eye movements
• Mental health exam
• Tests for the brain and nervous system and the gait
• Arterial blood gas tests measure the carbon dioxide and oxygen levels in the blood
• Drug screening

If the person is poorly nourished, the following tests are conducted to check the nutrition level:

• Serum albumin: It measures the albumin levels in the blood. If the results show low albumin levels, it may indicate vitamin B1 deficiency, kidney issues, and liver problems.
• Serum vitamin B1 levels: Here, the test shows the level of vitamin B1. If the levels are low, it may indicate vitamin B1 deficiency.
• Transketolase activity in the red blood cells

What are the various treatment options for Wernicke-Korsakoff Syndrome?

The treatment aims to control the symptoms and prevent the syndrome from worsening. Based on the symptoms, the following treatments are involved:

• Vitamin B1 tablets or injections
• Intravenous rehydration
• Treatment for alcoholism
• Medications
• Balanced diet 
• Physical therapy, if gait is affected
• Certain patients need constant monitoring and special care if they are in a coma

or experience lethargy 

However, it is essential to note that providing vitamin B1 treatment may not improve memory loss and intellect caused due to Korsakoff syndrome. 

What are the complications of Wernicke-Korsakoff syndrome?

The following are the possible complications of Wernicke-Korsakoff syndrome: 

• Challenges in personal and social interaction
• Frequent falls resulting in injury
• Long-lasting alcoholic neuropathy
• Lasting loss of thinking skills and loss of memory
• Decreased life expectancy

Conclusion

The Wernicke-Korsakoff syndrome needs immediate medical attention. Delay in medical attention may be fatal and can cause irreversible damage. Limited use of alcohol and a well-balanced diet is all it takes to prevent Wernicke-Korsakoff syndrome from developing. 

Frequently Asked Questions (FAQs)

How can one prevent Wernicke-Korsakoff syndrome?

A well-balanced diet and stopping or limiting alcohol helps prevent Wernicke-Korsakoff syndrome. 

Is Wernicke-Korsakoff syndrome curable?

The Wernicke-Korsakoff syndrome is not curable. However, treatment options can prevent the syndrome from worsening.