Wernicke-Korsakoff syndrome (WKS) may sound complex but it is simply a type of brain disorder caused by a lack of vitamin B1 (thiamine). As the name implies, there are two conditions comprising WKS. The first condition is Wernicke’s disease (WD), also called Wernicke’s encephalopathy (WE) and the second condition is Korsakoff syndrome (KS). People affected with WKS will have symptoms of Wernicke’s disease as well as those of Korsakoff syndrome.
The brain, and other major organs in the body require thiamine (vitamin B1) for proper functioning. In the brain, thiamine helps the brain cells to convert sugar into energy. When you have low thiamine levels, your brain is actually depleted of energy to function properly and that can manifests in the symptoms of WKS. These symptoms worsen overtime and can severely affect a person’s life, even leading to death. Experts say that an individual is likely to have symptoms of Wernicke’s disease, before the symptoms of Korsakoff syndrome will follow.
Chronic alcoholism and alcohol misuse is the most common cause of Wernicke-Korsakoff syndrome (WKS). But it can also be caused by any deficiency or medical condition that impairs the absorption of vitamin B1 in the body. Our bodies do not produce vitamin B1 and so it is only through our diet that the body is supplied with vitamin B1.
What are the Symptoms WKS?
WKS is a combination of Wernicke’s disease (or Wernicke’s encephalopathy) and Korsakoff syndrome, which both have their different symptoms. People with WKS will show symptoms of Wernicke’s disease before the symptoms of Korsakoff syndrome, which is long term, begin to develop gradually.
Low thiamine levels results in impaired brain function. This is what causes Wernicke’s encephalopathy and the symptoms include :
- Having double vision.
- Involuntary movement of the eye which is jerky (up-and-down, side-to-side).
- Ptosis (droopy eye lids).
- Mental confusion which can lead to violent behaviour.
- Difficulty walking and poor balance just like someone intoxicated with alcohol does.
- Low blood pressure when you stand.
- Faster heart beat
- Lack of energy.
These symptoms of Wernicke’s disease are similar to what you would experience after heavy drinking of alcohol. Therefore it can be difficult to diagnose Wernicke’s disease early enough in those who drink alcohol heavily. When this condition is not treated early, it can lead to coma and death.
Most people with Wernicke’s disease will end up developing Korsakoff syndrome even after treatment. The symptoms of Korsakoff syndrome affects the memory of a person and develops gradually and are chronic (long lasting). They include :
- Amnesia (difficulty remembering things).
- Problems understanding or learning new information.
- Having long term memory loss (in severe cases).
- Making up stories to filling in the gap created by memory loss (this is known as confabulation).
- Difficulty putting words into context.
Usually, symptoms of Korsakoff syndrome increase as the symptoms of Wernicke’s disease decrease. These symptoms of WKS can make day-to-day living very difficult for affected individuals and symptoms of Korsakoff symdrome could end up becoming permanent.
Who is Most at Risk of Developing WKS?
WKS typically affects people aged 45 – 65. Heavy, long-term alcohol use is the no.1 cause and risk factor for developing WKS. This is because alcohol affects the body’s ability to absorb, store and make use of vitamin B1. Generally, men are more prone to developing WKS than women because they consume alcohol more. Likewise, homeless people, adults who live alone and those with mental problems like depression are more likely to abuse alcohol and not eat well which increase their risk of developing WKS.
People who don’t get enough nutrients of vitamin B1 from their diet also are at risk of developing WKS. In addition, certain health conditions that interfere with absorption of vitamin B1 can put you at risk of developing WKS. Examples are :
- Cancer (gastric cancer, colon cancer).
- Eating disorders especially anorexia.
- Serious kidney problems that require dialysis.
- Chemotherapy treatment for cancer.
- Severe and persistent vomiting.
- Extreme dieting or fasting.
- Weight loss surgery, also known as gastric bypass surgery.
Diagnosis and Complications
Diagnosing WKS requires a combination of history taking, physical examination, mental examination, laboratory tests and imaging studies. Your doctor will try to rule out other problems that could be responsible for your symptoms like brain tumor or stroke.
Important blood test include checking your serum vitamin B1 test, serum albumin test, kidney function test and liver function test. Your doctor will also perform eye examination and also examine your gait (how you walk) on addition to a mental examination and assessment. All these will help him know whether for sure your symptoms are due to WKS. CT-scan and MRI scan of the brain are part of the imaging studies you will be asked to do.
The major complications that may result due to WKS include :
- Alcohol withdrawal.
- Difficulty with personal or social interaction.
- Permanent alcoholic neuropathy.
- Injury caused by falls.
- Permanent loss of thinking skills.
- Permanent loss of memory.
- Shortened life span.
Treatment and Prevention
The most effective way to treat symptoms of WKS, especially those of Wernicke’s encephalopathy is through thiamine (vitamin B1) supplementation. People with severer symptoms will need intravenous (IV) thiamine and this requires hospitalization.
Symptoms of Korsakoff syndrome are less likely to show signs of improvement even with thiamine treatment and may require further management. However, prompt thiamine treatment may prevent further deterioration of symptoms.
To prevent the progression of the syndrome, a person with WKS will have to abstain completely from alcohol and follow a well-balanced diet. If alcohol is not the cause, treatment for the underlying medical problem is necessary.
In order to keep WKS at bay, stay away from alcohol and be sure to eat foods that supply good amounts of thiamine. Foods high in thiamine (vitamin B1) include:
- Enriched rice
- Soy beans
- Lima beans
- Yeast extract
- Seeds, including sunflower, chia, pumpkin, and squash
- Nuts, including macadamia, pistachio, and brazil nuts
- Whole grains
- Medical News Today – what is wernicke-korsakoff syndrome
- WebMD – wernicke-korsakoff syndrome
- Health line – Wernicke-korsakoff syndrome
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