Wernicke-Korsakoff syndrome

Alternative names:

alcoholic encephalopathy; encephalopathy, alcoholic; Korsakoff psychosis; Wernicke's disease

Symptoms:

• vision changes
  • double vision
  • eye movements, uncontrollable or twitching of the eyes
  • eyelid drooping

• loss of muscle coordination
  • unsteady, uncoordinated walking
  • weakness
  • movement, dysfunctional
  • hand tremor

• muscle contractions
• muscle atrophy
• facial paralysis
• sensation changes
  • decreased sensation in the feet or hands, numbness
  • abnormal sensations, tingling

• thin, malnourished appearance
• loss of hair
• dry skin
• swallowing difficulty
• speech impairment
• hoarseness or changing voice
• mood changes, emotional changes, and behavior changes
• loss of memory, can be profound
• confabulation
• decreased intellect/cognitive skills
  • decreased problem solving
  • loss of ability to think abstractly

• autonomic disturbances:
  • orthostatic dizziness
  • constipation
  • inability to tolerate cold environment

Note: Symptoms that indicate alcohol withdrawal may also be present or may develop.

Signs and tests:

History is significant for chronic alcohol use. Examination of the nervous/muscular system may show polyneuropathy (damage to multiple nerve systems). Reflexes may be decreased or of abnormal intensity, or abnormal reflexes may be present. Testing of gait and coordination indicate damage to portions of the brain that control muscle coordination. Muscles may be weak and may show atrophy (loss of tissue mass). Examination of the eyes shows abnormalities of eye movement. Blood pressure and body temperature measurement may be low; pulse (heart rate) may be rapid. The person may appear cachectic (malnourished).

A nutritional assessment may confirm malnourished state, serum B-1 levels may be low, pyruvate is elevated, and transhetolase activity is decreased. Serum or urine alcohol levels may be elevated (see toxicology screen).

A cranial MRI rarely shows changes in the tissue of the brain indicating Wernicke-Korsakoff syndrome.