Wernicke-Korsakoff Syndrome or ’Wet Brain’
Background: In 1881, Carl Wernicke first described an illness that consisted of paralysis of eye movements, inability to coordinate voluntary muscle movements, and mental confusion in 3 patients. The patients, 2 males with alcoholism with progression to coma and death. Wernicke detected holes and bleeding affecting the gray matter in some parts of the brain.
S.S. Korsakoff, a Russian psychiatrist, described the disturbance of memory in the course of long-term alcoholism in a series of articles from 1887-1891.
In 1897, Murawieff first postulated that a single cause of a disease was responsible for both syndromes – Wernicke syndrome and Korsakoff syndrome. Or, in common terms – ‘wet brain’.
The term Wernicke encephalopathy is used to describe the symptom complex of paralysis of some nerves of the eye, inability to coordinate voluntary muscle movements, and an acute confusional state. If persistent learning and memory deficits are present, the symptom complex is termed Wernicke-Korsakoff syndrome.
Cause; A lack of thiamine (vitamin B-1) is responsible for the symptom manifested in Wernicke-Korsakoff syndrome, and any condition resulting in a poor nutritional state places drinkers at risk.
Heavy, long-term alcohol use is the most common association with Wernicke-Korsakoff syndrome. Alcohol interferes with active stomach juice transport, and chronic liver disease leads to decreased activation of thiamine, as well as a decreased capacity of the liver to store thiamine.
- Prevalence data have come primarily from post-mortem studies, with rates of 1 to 3%.
- The rate has been found to be significantly higher in specific populations, ie, homeless people, older people (especially those living alone or in isolation), and psychiatric inpatients, where alcohol use and poor nutritional states predominate.
- The death rate is 10-20%. That is if you get it you have a 10 to 20% chance of an early death.
- In general, full recovery of eye function occurs. Fine horizontal eye movement can persist in as many as 60% of cases.
- Approximately 40% of patients have complete recovery from inability to coordinate voluntary muscle movements.
- Only 20% of patients recover completely from partial loss of memory deficit.
- The rates of the disease are similar across races.
- The condition affects males slightly more frequently than it affects females.
- Age of onset is evenly distributed from 30-70 years.
- Painless vision abnormalities
- Double vision
- Wide-based, short-stepped gait
- Inability to stand or walk without assistance
Mental status changes
- Apathy, indifference, insufficient speech
- Hallucination, agitation
- Confabulation: Patient fills in gaps of memory with data that can be recalled at that moment.
Medical Care: Wernicke encephalopathy is a medical emergency. Prompt recognition of the symptoms and a high index of suspicion are crucial to ensure early treatment. Intravenous thiamine (50-100 mg) is the treatment of choice.
Early treatment can rapidly reverse the eye problems and improve inability to coordinate voluntary muscle movements and early mental confusion, as well as prevent development of the partial loss of memory state. In advanced cases, where severe prolonged deficiency has led to permanent structural brain damage, permanent thinking deficits remain.
Long-term alcohol use is the most common etiology for Wernicke-Korsakoff syndrome, and abstinence provides the best chance for recovery. Referral to an alcohol recovery program should be part of the treatment regimen.
A balanced diet should be resumed as early as possible. Vitamin and should be adhered to in addition to a well-balanced diet initially, and supplementation can be tapered as the patient resumes normal intake and demonstrates improvement.
Due to gait abnormalities, unassisted ambulation is discouraged during the initial phase of treatment. Patients may require physical therapy evaluation for gait assistance. Gait abnormalities may be permanent, depending on the severity at initial presentation and the timeliness of therapy.
Recovering patients will require outpatient follow-up care to evaluate for continued progress or relapse.
Patients should continue taking thiamine supplementation, as well as other vitamins and electrolytes, until a well-balanced diet can be maintained. Long-term supplementation may be required in patients who cannot maintain adequate nutritional intake, whether from noncompliance or the underlying disorder.