Wernicke–Korsakoff’s Syndrome

Wernicke’s encephalopathy is a form of acute brain injury resulting from a lack of thiamine (vitamin B1) that most commonly occurs in chronically alcohol dependent people. In alcohol dependent patients thiamine deficiency occurs due to poor dietary intake and/or intestinal malabsorption. It is estimated that healthy subjects absorb 5 per cent of an oral dose of thiamine, compared to only 1.5 per cent in alcohol-dependent subjects. Wernicke’s encephalopathy is an important comorbidity rather than a withdrawal complication; it is usually identified in acute hospital presentations, including patients presenting with alcohol withdrawal. It can co-exist with and should be distinguished from acute alcohol withdrawal, hepatic encephalopathy, and other causes of confusion. 

Wernicke’s encephalopathy is initially reversible, but if untreated or inadequately treated can lead to Korsakoff’s syndrome, a chronic and disabling condition characterised by severe short-term memory loss and impaired ability to acquire new information that often presents with compensatory lying, confabulation. Approximately one-quarter of patients with Wernicke’s encephalopathy recover completely if treated appropriately, one-quarter show significant improvement, one-quarter only partially recover, and one-quarter show no improvement over time. Approximately one-quarter requires long-term institutional care. It is imperative that treatment is initiated early as delays in treatment may worsen the patient’s prognosis. No effective treatment of Korsakoff’s syndrome has been found highlighting the importance of prevention or early diagnosis.