Wernicke-Korsakoff Syndrome: a Narrative Review

Abstract

Background: Wernicke-Korsakoff syndrome encompasses the classic triad of confusion, ataxia and ophthalmoplegia. It was first described by Carl Wernicke. Sergei Korsakoff described a case of amnesia associated with chronic alcoholism. Murawieff proposed a common etiology for the two syndromes. However, the complete triad is an unusual presentation, which leads to underdiagnosis, particularly in an emergency context.

Aims: To review current literature on the Wernicke- Korsakoff syndrome, with review of historical aspects, etiopathogenesis, neuropathology, differential diagnoses, clinical aspects, treatment and prognosis. This article aims to contribute to a better diagnostic sensitivity of this pathology.

Methods: Non-systematic review of the literature available in the PubMed database using the keywords “Wernicke Encephalopathy”, “Korsakoff Syndrome” and “Alcoholic Korsakoff Syndrome”.

Results and Conclusions: Wernicke-Korsakoff Syndrome is a neuropsychiatric condition caused by a deficiency of vitamin B1(thiamine). Although it is more prevalent in chronic alcoholism, any nutritional deficiency may be associated with thiamine deficit.  Therefore, any element of the triad, with changes in mental status being the most common, associated with a nutritional risk factor should raise clinical suspicion. Later symptoms, such as the alteration of vital signs (hypotension, hypothermia and signs of respiratory distress) should not rule out the diagnostic hypothesis, but rather be understood as the progression of the disease, with involvement of the brainstem. High-dose parenteral thiamine should be initiated in any patient suspected of having Wernicke's Encephalopathy. Due to the serious amnestic sequelae, with great impact on quality of life, of untreated Korsakoff Syndrome and the safety of thiamine, it is preferable to start treatment as soon as there is clinical suspicion of Wernicke-Korsakoff Syndrome. The overtreatment is preferable, given its safety profile and avoiding the severe amnesic sequelae, with great impact on the quality of life, of Korsakoff's syndrome in the absence of treatme