Wernicke Korsakoff Psycosis

INTRODUCTION:
  • Wernicke -Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1).
  • Wernicke -Korsakoff syndrome is most commonly caused by alcohol misuse, but certain other conditions also can cause the syndrome.
  • Thiamine (vitamin B-1) helps brain cells produce energy from sugar. When levels fall too low, brain cells cannot generate enough energy to function properly. As a result, Korsakoff syndrome may develop.
  • Wernicke encephalopathy and Korsakoff syndrome are different conditions that often occur together. Both are due to brain damage caused by a lack of vitamin B1.
  • Neuropathological lesion caused by thiamine deficiency is usually widespread but most consistent changes are seen in bilateral dorsomedial (& anterior) nucleus of thalamus, mammillary bodies, and hippocampus, in form of small vessels hyperplasia; petechial hemorrhages, astrocytic hypertrophy & degeneration. It disrupts a critical circuit between hippocampus & frontal lobes. The changes are also seen in periventricular (around 3rd ventricle), periaqueductal grey matter, cerebellum, and brain stem (midbrain, pons, medulla fornix) as symmetrical lesions.
ETIOLOGY:
  • Alcohol misuse
  • Anorexia, 
  • Overly-stringent dieting, 
  • Fasting, starvation or weight-loss surgery; 
  • Uncontrolled vomiting; 
  • AIDS; v Kidney dialysis; chronic infection; or cancer that has spread throughout the body.
SYMPTOMS:
  • Symptoms of Wernicke encephalopathy include:
  1. Confusion and loss of mental activity that can progress to coma and death
  2. Loss of muscle coordination (ataxia) that can cause leg tremor
  3. Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping
  4. Opthalmoplegia
  5. Alcohol withdrawal
  • Symptoms of Korsakoff syndrome:
  1. Inability to form new memories
  2. Loss of memory, can be severe
  3. Thalamus is responsible for the amnestic defect
  4. Psychosis
  5. Making up stories (confabulation)
  6. Seeing or hearing things that are not really there (hallucinations)
DIAGNOSIS:
  • Examination of the nervous/muscular system may show damage to many nerve systems:
  1. Abnormal eye movement
  2. Decreased or abnormal reflexes
  3. Fast pulse (heart rate)
  4. Low blood pressure
  5. Low body temperature
  6. Muscle weakness and atrophy (loss of tissue mass)
  7. Problems with walk (gait) and coordination
  • The person may appear poorly nourished. The following tests are used to check a person's nutrition level:
  1. Serum albumin (relates to person's general nutrition)
  2. Serum vitamin B1 levels
  3. Transketolase activity in red blood cells (reduced in people with thiamine deficiency)
TREATMENT:
  • Monitoring and special care may be needed if the person is:
  1. In a coma
  2. Lethargic
  3. Unconscious
  • Vitamin B1 may be given by injection into a vein or a muscle, or by mouth. This may improve symptoms of:
  1. Confusion or delirium
  2. Difficulties with vision and eye movement
  3. Lack of muscle coordination
  • Vitamin B1 often does not improve loss of memory and intellect that occur with Korsakoff psychosis.
  • Stopping alcohol use can prevent more loss of brain function and damage to nerves. A well-balanced, nourishing diet can help, but it is not a substitute for stopping alcohol use.
Exam Question
  • Alcoholic presents with psychosis and memory loss is suggestive of Wernicke’s Korsakoff psychosis
  • Opthalmoplegia, ataxia, Psychosis are features of Wernicke's Korsakoff Syndrome
  • Mammilary body,Thalamus & Hippocampus are affected in Wernicke's Korsakoff Syndrome
  • Thalamus is responsible for the amnestic defect in Wernicke's Korsakoff syndrome
  • Wernicke-Korsakoff's syndrome is due to the deficiency of thiamine

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