Wernicke Encephalopathy & Korsakoff Syndrome

Key Features

• 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

Clinical Findings

• 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

Diagnosis

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

Treatment

• 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