A29. Wernicke-Korsakoff syndrome Flashcards
Wernicke-Korsakoff Syndrome (WKS)- what is it
is brain damage caused by thiamine (vitamin B1) deficiency,
usually secondary to chronic alcoholism or malnutrition.
what is Thiamine and what is it involved in
- is an essential vitamin,
- its phosphorylated derivatives are involved in many cellular processes, including the catabolism of sugars and amino acids.
what are the most vulnerable organs to thiamine deficiency
The brain and cardiovascular system are
the most vulnerable
* hence CNS and cardiac symptoms (hypotension, tachycardia)
are seen in WKS.
what are the CNS and cardiac symptoms
seen in Wernicke-Korsakoff Syndrome WKS and why
- hypotension
- tachycardia
because brain and cardiovascular system are the most vulnerable to thiamine deficiency
Foods rich in thiamine
- lean pork,
- rice,
- spinach,
- peas,
- whole wheat
Wernicke-Korsakoff syndrome is by definition
when symptoms of two different conditions are seen together;
* Wernicke´s Encephalopathy (WE) and
* Korsakoff Syndrome (KS).
when symptoms of:
* Wernicke´s Encephalopathy (WE) and
* Korsakoff Syndrome (KS)
are seen together
Wernicke-Korsakoff syndrome
Wernicke encephalopathy
-is it acute or chronic?
-reversible or irreversible?
acute and reversible
Wernicke encephalopathy Symptoms commonly show the classic triad of:
-
Oculomotor dysfunction
○ Horizontal and vertical nystagmus, diplopia, ophtalmoplegia, ocular nerve palsy, gaze palsy, anisocoria, dysconjugated eye movements, ptosis - Trunk and gait ataxia
-
Encephalopathy
○ Confusion, apathy, disorientation, memory problems, psychosis, delirium, if severe can progress to stupor and coma
Oculomotor dysfunction symptoms in Wernicke encephalopathy
- Horizontal and vertical nystagmus,
- diplopia,
- ophtalmoplegia,
- ocular nerve palsy,
- gaze palsy
- anisocoria,
- dysconjugated eye movements,
- ptosis
Encephalopathy symptoms in Wernicke encephalopathy
- Confusion,
- apathy,
- disorientation,
- memory problems,
- psychosis,
- delirium,
- if severe can progress to stupor and coma
Wernicke encephalopathy where are the lesions?
Lesions are
* bilateral
* around 3 rd and 4 th ventricle
* and the cerebral aqueduct.
are lesion unilateral or bilateral in Wernicke encephalopathy
bilateral
if Wernicke encephalopathy is left untreated what happens
Can lead to fatal lactic acidosis if left untreated
Korsakoff Syndrome is it acute or chronic
reversible or irreversible
chronic
* only 20 % reversible with treatment
is Korsakoff Syndrome reversible?
only 20 % reversible with treatment
Korsakoff Syndrome symptoms
memory symptoms
* Anterograde amnesia (problems learning new information) and short-term memory loss
* Confabulations (make up information to fill memory gaps)
* Disorientation in time and space
which of the 2 precedes the other
wernicke encephalopathy and korsakoff syndrome
- Wernicke Encephalopathy usually precede Korsakoff syndrome, and
- symptoms of WE tends to
decrease as KS develops.
how do symptoms of WE change as KS develops
symptoms of WE tends to
decrease as KS develops.
Wernicke-Korsakoff Syndrome is suspected if
If symptoms of Wernicke´s encephalopathy is associated with memory disturbances
Wernicke-Korsakoff syndrome Etiology
Deficiency of vitamin B1 (thiamine), due to:
- Chronic alcoholism (most common)
- Malnutrition (starvation, eating disorders, gastric surgery, cancer, prolonged vomiting etc) →
decreased absorption of thiamine
- Kidney dialysis can also decrease absorption of thiamine
- AIDS can also be seen in background of WKS
Deficiency of vitamin B1 (thiamine), can be due to:
- Chronic alcoholism (most common)
- Malnutrition (starvation, eating disorders, gastric surgery, cancer, prolonged vomiting etc) →
decreased absorption of thiamine - Kidney dialysis can also decrease absorption of thiamine
- AIDS can also be seen in background of WKS
Diagnosis of Wernicke-Korsakoff Syndrome
Clinical diagnosis, based on
- Clinical evaluation and history
- Looking for possible causes by lab screenings (e.g albumin for malnutrition or kidney/liver problems) and LFTs
- Strengthen suspicion with thiamine and erythrocyte transketolase activity (both reduced)
- ECG to look for cardiac symptoms
- CT / MRI to rule out other CNS causes (tumor, stroke etc.) – can also show signs of
Wernicke-Korsakoff syndrome (shrunken mammillary bodies and lesions for example)
- Treatment improve symptoms
Treatment of Wernicke-Korsakoff Syndrome
- Thiamine replacement therapy (iv, because abdominal absorption is often hampered)
- Treat underlying condition (alcohol abstinence, psychotherapy etc)
Prognosis of Wernicke-Korsakoff Syndrome
- Depends of disease progression before treatment
- Without treatment the mortality is high
what lab screening are done for possible causes of Wernicke-Korsakoff Syndrome
- (e.g albumin for malnutrition or kidney/liver problems) and
- LFTs
which tests Strengthen suspicion of Wernicke-Korsakoff Syndrome ?
- thiamine
- erythrocyte transketolase activity (both reduced)
why is ECG is done in Wernicke-Korsakoff Syndrome
to look for cardiac symptoms
CT / MRI is done in suspicioun of Wernicke-Korsakoff Syndrome to rule out what?
- other CNS causes (tumor, stroke etc.)
- can also show signs of
Wernicke-Korsakoff syndrome (shrunken mammillary bodies and lesions for example)
sign on MRI/CT of Wernicke-Korsakoff syndrome
- can also show signs of
Wernicke-Korsakoff syndrome (shrunken mammillary bodies and lesions for example)
hows the mortality Without treatment in Wernicke-Korsakoff Syndrome
mortality is high
Thiamine replacement therapy - how is it administered and why?
(iv, because abdominal absorption is often hampered)
