Wernicke’s Encephalopathy and Korsakoff’s Syndrome

Acute and chronic phase (respectively) of the same disease process.

Wernicke’s Encephalopathy

A clinical tetrad of:

  • Acute confusional state
  • ophthalmoplegia- commonly CN VI palsy
  • nystagmus
  • ataxic gait

with associated features including:

  • peripheral neuropathy
  • resting tachycardia
  • nutritional deficiency
  • sluggish pupillary reflexes
  • Anisocoria (unequal pupils)

It is caused by a thiamine deficiency, resulting in microhaemorrhages and secondary gliosis of periaqueductal grey matter.

Treat with parenteral thiamine as soon as diagnosis is suspected.  There is a high mortality (15%) if untreated.

Korsakoff’s syndrome

Characterised by:

  • Anterograde amnesia (inability to form new memories)
  • Retrograde amnesia (inability to remember old memories)
  • Confabulation (fabricating/false perceptions of memories)
  • Hallucinations

The damage to the memory is mostly irreversible (75% never regain full function).

Treat with thiamine for 2 years.

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