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Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Wernicke encephalopathy is caused by thiamine (vitamin B1) deficiency and is typically seen in alcoholics or those who self-neglect. It presents with the classic triad of confusion, ataxia and ophthalmoplegia. Korsakoff psychosis is the chronic form of the condition and is characterised by confabulation and memory loss. MRI findings include symmetrical high signal on T2 and FLAIR sequences with post-contrast enhancement in the mammillary bodies, basal ganglia, paraventricular/medial thalamic regions, brain stem and periaqueductal grey matter. Korsakoff syndrome is associated with mammillary body atrophy and dilatation of the third ventricle.
Central nervous system depressants
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Assessment of adolescents with alcohol-related problems, particularly when they may have comorbid disorders, such as poor nutrition, eating disorders or mental health problems, should include neurological assessment to enable detection of brain damage related to alcohol use (Brown et al., 2009). Studies of neurocognitive function in young people aged 15–19 years with a history of heavy binge drinking and alcohol abuse show impairment in neurocognitive and neurobehavioural functions similar to the frontal function deficits observed in patients with Korsakoff psychosis (Brown et al., 2000; Garcia-Moreno et al., 2008).
Alcohols and Aldehydes
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
The full clinical presentation is rarely encountered, but it is believed to be associated with thiamine deficiency due to reduced thiamine (vitamin B1) absorption in alcoholics. Wernicke’s encephalopathy is the acute phase of the disease, with longer duration of the confusional state in comparison with acute ethanol intoxication. Administration of thiamine alleviates the ataxia, ocular difficulty, and confusion; however, a memory deficit, known as Korsakoff psychosis, may linger. Moreover, ethanol may cause bilateral and symmetrical visual impairment because of optic nerve degeneration.
Thiamine supplementation in hospitalized patients with altered mental status: does it help?
Published in Hospital Practice, 2022
Daniel J. Zhou, Kaeli K. Samson, Navya Joseph, Ismail Fahad, Matthew V. Purbaugh, Brian J. Villafuerte-Trisolini, Neeharica Kodali, Purnima Guda, Wendie Grogan, Urmila Mukherjee, Sachin Kedar
Thiamine supplementation is a well-established practice in the management of patients with acute encephalopathy in the setting of alcohol use disorder [9–11]. Administration of intravenous (IV) thiamine prior to glucose or equivalent products is standard of care for patients with suspected Wernicke encephalopathy in the acute setting to prevent irreversible neurological injury (Korsakoff psychosis) [12,13]. After several days of intravenous use, thiamine supplementation may safely be switched from IV to enteral[14]. Supplemental thiamine can reduce morbidity through enhanced aerobic energy production and increased lactate clearance[15]. Despite these recommendations, there is poor compliance with thiamine supplementation for hospitalized patients including high-risk patients [16,17].
Alcohol and melatonin
Published in Chronobiology International, 2021
In addition to these internal diseases, alcohol abuse leads to injury of the nervous system. This includes neurological and mental disorders, such as alcoholic polyneuropathy and typical alcoholic lesions of the central nervous system like seizures, typical variants of alcohol delirium, Wernicke’s encephalopathy, Korsakoff psychosis, or alcohol dementia (Tsuang et al., 2011). This was convincingly shown in the report of the Institute of Alcohol Studies (2007). It is additionally the cause of atypical alcohol delirium, alcoholic paranoia, acute and chronic alcohol hallucinosis, and alcohol delusions (Mukherjee 2013). Elucidation of the basic mechanisms of the course of these diseases has helped to identify and determine the main direct alcohol markers (Brien et al. 2011; Cabarcos et al. 2015; Philibert and Erwin 2015).