Wernicke-Korsakoff Syndrome

In patients who are alcoholics it is imperative that you never give glucose without giving thiamine first. Doing so can precipitate Korsakoff syndrome, a constellation of symptoms including anterograde and retrograde amnesia, confabulation, and sometimes hallucinations. It is usually associated with Wernicke Encephalopathy, but not always. Sometimes patients have had subacute Wernickes and then develop overt Korsakoff syndrome with administration of glucose without thiamine.

Wernicke Encephalopathy is a constellation of symptoms including confusion, nystagmus, blurred vision, and ataxia. It is caused by alcoholism and can be viewed with MRI as edematous mamillary bodies, grey matter around the aqueduct and ventricles, and thalamus. As the swelling goes down, atrophy occurs.

Many more people have Wernicke-Korsakoff Syndrome than we diagnose and are found on autopsy. Getting an arterial blood gas on alcohol patients on admission can often give us clues to diagnosis. A combination of primary metabolic acidosis and primary respiratory alkalosis is often found in Wernicke-Korsakoff Syndrome.