ENCEPHALOPATHY-KORSAKOFF SYNDROME

SUMMARY

1. Chronic amnestic syndrome associated with alcoholism, malnutrition, and thiamine deficiency; may emerge as Wernicke's is treated.

2. Amnesia can be both retrograde and anterograde. Attention and mentation appear normal (difference between Korsakoff vs Wernickie's).

3. Patients often confabulate because of the memory problems. The stories are frequently happy-go-lucky fantasies.

4. Typical presentation: an underweight, poorly nourished, but very attentive alcoholic who tells fantastical stories that couldn't possibly be true and then has no memory of the discussion.

5. Other manifestations: peripheral neuropathy, retrobulbar optic neuropathy, impaired olfactory discrimination, and postural hypotension.

6. Treatment is with thiamine. IV glucose can precipitate Wernicke encephalopathy in alcoholics. Remember: give IV thiamine before IV glucose.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].