Recovery Begins Here
Call 24/7 (844) 557-8575

We’re open everyday 24/7
Get help now
Free & confidential

(844) 557-8575

Understanding Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff syndrome (WKS) is actually two conditions: Korsakoff syndrome and Wernicke disease. The Wernicke disease component of WKS is also referred to as Wernicke’s encephalopathy.

In most cases, people experience Wernicke’s encephalopathy symptoms first. As the condition progresses, symptoms of Korsakoff syndrome present themselves.

Subdivisions of this syndrome are:

  • Korsakoff amnesic syndrome
  • Korsakoff syndrome
  • Wernicke disease
  • Wernicke syndrome
  • Korsakoff psychosis
  • Psychosis polyneurotica
  • Wernicke encephalopathy

Causes and Risk Factors

Both of the conditions that make up Wernicke-Korsakoff syndrome occur due to brain damage resulting from a vitamin B1 (thiamine) deficiency.

Begin the path to lasting recovery.

Call Now (844) 557-8575

All people who chronically abuse alcohol are at risk for thiamine deficiency. This can happen due to chronic alcohol consumption causing poor absorption of this nutrient in the gastrointestinal tract, inadequate dietary intake, and the cells not utilizing thiamine properly. 

In industrialized countries, thiamine deficiency’s most common cause is chronic alcohol use disorder. Thiamine deficiency occurs in up to 80 percent of the people who have an enduring alcohol use disorder. 
The most common cause of WKS is chronic alcohol misuse or alcoholism. Other possible causes include conditions that make it hard for the body to absorb thiamine, certain cancers, and eating disorders.

Possible Symptoms

The initial symptoms are due to Wernicke disease (WD), which occurs before Korsakoff syndrome. The symptoms of Wernicke’s include:

  • Double vision
  • Eye movements going side to side or up and down
  • Confusion, which may lead to violent behavior or combativeness
  • Drooping upper eyelid
  • Loss of muscle coordination

In the most severe of cases, the person can progress to coma or death. When this occurs, it is usually after the person exhibits a profound loss of mental activity and confusion.

WD can eventually become Korsakoff syndrome. Once someone has WKS, they usually have noticeable issues with their memory, such as not being able to form new memories and memory loss. Other possible symptoms of WKS may include:

  • Trouble understanding what new information means
  • Hallucinations
  • Amnesia with events that occur after developing WKS
  • Having a hard time putting words into context
  • Confabulation or exaggerated storytelling

Making a Diagnosis

It can sometimes be difficult to make an accurate diagnosis of Wernicke-Korsakoff syndrome. This is because people may not be able to effectively communicate with their doctor due to mental confusion. The doctor may focus on the confusion and overlook a physical disorder like WKS.

Once the condition is suspected, the doctor may look for the signs of alcoholism.

Since liver damage is common among people with an alcohol use disorder, running a liver function test is common. The doctor may also test blood alcohol levels. Both of these are types of blood tests.

Liver enzymes are commonly elevated as a result of liver disease.

The doctor may look for the physical manifestations that can occur as a result by checking the following:

  • Heart rate
  • Reflexes
  • Body temperature
  • Eye movements
  • Blood pressure

The next step is looking to see if the person has a thiamine deficiency. This usually involves ordering a serum vitamin B1 test. The doctor may also order a serum albumin test since this can provide some insight on liver or kidney problems, as well as nutritional deficiencies. Both of these are blood tests.

The doctor may ask the person about the symptoms of thiamine deficiency, which may include the following:

  • Increased heart rate
  • Lower leg swelling
  • Shortness of breath
  • Enlarged heart
  • Bulging neck veins
  • Fluid in the lungs
  • Sensation loss in the feet and hands
  • Mental confusion
  • Speech difficulties
  • Tingling
  • Difficulty walking
  • Paralysis or muscle function loss in the lower legs
  • Pain
  • Abnormal eye movements
  • Vomiting

There are a few other tests that doctors might order depending on the symptoms and overall health:

  • Electrocardiogram to see if there are cardiac abnormalities
  • MRI scan to look for WKS-related brain changes
  • CT scan to look for WKS-related brain lesions
  • Neuropsychological testing to evaluate mental deficiency severity

Treatment Options

Getting prompt treatment as soon as the condition begins may help to stop or delay disease progression. For some people, certain treatments may reverse brain abnormalities that are not permanent.

Initially, the person may need to be hospitalized. This is to ensure they are getting adequate thiamine and other nutrition. They may receive:

  • Intravenous thiamine
  • A balanced diet
  • Oral thiamine supplementation

It is possible to experience side effects associated with intravenous or oral thiamine supplementation. These may include confusion, hallucinations, or agitation. Side effects tend to be more common in people with alcohol use disorder.

While undergoing treatment with thiamine, people can start to experience alcohol withdrawal symptoms such as:

  • Nausea and vomiting
  • Anxiety
  • Sweating
  • Tremors
  • Headache
  • Confusion or irritability
  • Increased heart rate
  • Nightmares or insomnia
  • Sweating
  • High blood pressure

Doctors can prescribe medications and other supportive care to help someone be more comfortable when they are detoxing from alcohol. Intravenous fluids to ensure hydration are commonly given. The doctor might also prescribe benzodiazepines to relax the person.

Ensuring proper nutrition is important to help with alcohol withdrawal and restoring thiamine levels. Depending on the level of malnourishment, the person may also be prescribed other supplements to restore nutrient levels as they recover from alcohol abuse disorder and WKS.

If alcohol abuse is the underlying cause of this disorder, they may be referred to treatment for alcoholism. This typically begins with a medically supervised detox before they go into a long-term treatment program.

Outlook

When people are diagnosed in the early stages of Wernicke-Korsakoff syndrome, their prognosis is usually favorable. Late-stage diagnoses can have a poorer outlook. 

In severe cases, the mortality rate is about 10 to 15 percent. Mortality may be secondary to liver failure or infections, such as sepsis or a lung infection. In some cases, death occurs as a result of prolonged and severe thiamine deficiency causing irreversible defects, such as brain damage.

Prompt treatment in the early stages may help to alleviate problems with muscle coordination, the eyes, and confusion. For recovery to occur, the person must abstain from alcohol.

Even with prompt treatment and complete alcohol abstinence, the improvement in memory is usually slow and often incomplete. It is not possible to determine the extent of memory issues they will have long term. 
Getting treatment as early as possible is imperative for a more positive prognosis. Because of this, anyone who suspects they have Wernicke-Korsakoff syndrome must be evaluated by a doctor right away.

Sources

Wernicke-Korsakoff Syndrome. National Organization for Rare Disorders. from https://rarediseases.org/rare-diseases/wernicke-korsakoff-syndrome/

(Mar-Apr 2009) Neuroimaging of the Wernicke-Korsakoff Syndrome. Alcohol and Alcoholism. from https://academic.oup.com/alcalc/article/44/2/155/184909

(2003) The Role of Thiamine Deficiency in Alcoholic Brain Disease. National Institute on Alcohol Abuse and Alcoholism. from https://pubs.niaaa.nih.gov/publications/arh27-2/134-142.htm

Thiamine. National Institutes of Health Office of Dietary Supplements. from https://ods.od.nih.gov/factsheets/Thiamin-HealthProfessional/#h5

Wernicke-Korsakoff Syndrome. MedlinePlus. from https://medlineplus.gov/ency/article/000771.htm

(February 2018) Beriberi: Understanding Thiamine (Vitamin B1) Deficiency. Verywell Health. from https://www.verywellhealth.com/beriberi-understanding-thiamine-deficiency-4158113

(April 2018) Alcohol Withdrawal Syndrome. Healthline. from https://www.healthline.com/health/alcoholism/withdrawal

(May 2018) What is the Mortality of Wernicke-Korsakoff Syndrome (WKS)? Medscape. from https://www.medscape.com/answers/288379-91427/what-is-the-mortality-of-wernicke-korsakoff-syndrome-wks

Wernicke-Korsakoff Syndrome Information Page. National Institute of Neurological Disorders and Stroke. from https://www.ninds.nih.gov/Disorders/All-Disorders/Wernicke-Korsakoff-Syndrome-Information-Page

We've Helped Thousands Overcome Addiction

Call Now (844) 557-8575

COVID-19 Advisory: We are accepting patients and offering telehealth options. Click here for more information.