Wernicke Encephalopathy & Korsakoff Syndrome

Caused by thiamine deficiency

In United States, occurs most commonly in patients with alcohol use disorder

It may also occur in patients with AIDS, in patients with hyperemesis gravidarum, or after bariatric surgery

Wernicke syndrome

• Triad of confusion, ataxia, and nystagmus leading to ophthalmoplegia (lateral rectus muscle weakness, conjugate gaze palsies)

• Peripheral neuropathy may be present

Korsakoff syndrome

• Occurs in more severe cases of thiamine deficiency

• Includes anterograde and retrograde amnesia and sometimes confabulation

• May not be recognized until after an initial delirium has lifted

Confirmed by the response to treatment within 1 or 2 days, which must not be delayed while laboratory confirmation is obtained

In suspected cases, thiamine 100 mg, is given intravenously immediately and then intramuscularly on a daily basis until a satisfactory diet can be ensured after which the same dose is given orally

Initial doses of 200–500 mg intravenously three times daily for the first 5–7 days of treatment has been recommended

Intravenous glucose given before thiamine may precipitate the syndrome or worsen the symptoms