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Vitamin Deficiencies – Diagnosis and Treatment
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Wernicke-Korsakoff’s syndrome includes Wernicke’s encephalopathy and Korsakoff’s syndrome, which are distinct disorders but often occur together in patients with AUD who do not consume adequate amounts of thiamin-fortified foods. Wernicke’s encephalopathy is characterized by psychomotor slowing, nystagmus, ataxia, ophthalmoplegia (paralysis or weakness of eye muscles), and impaired consciousness. Korsakoff’s syndrome is characterized by memory deficits. If left untreated Wernicke-Korsakoff’s syndrome will lead to coma and death.11
Diagnosis of Dementia
Published in Dawn Brooker, Sue Lillyman, Mary Bruce, Dementia Care, 2023
Dawn Brooker, Sue Lillyman, Mary Bruce
There are several specific types of ARBD. The two most common types are: alcohol-related ‘dementia’ caused from damage of excessive drinking over a period of time;Wernicke–Korsakoff syndrome (Korsakoff Syndrome) caused specifically by the lack of thiamine normally through drinking over a period of time. Wernicke–Korsakoff syndrome has two stages. Firstly, there will be intense inflammation (swelling) of their brain. known as ‘Wernicke’s encephalopathy’. If not treated as an emergency this can lead to long term brain damage and ‘Korsakoff’s syndrome’ or possibly death.
Korsakoff Syndrome
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
(STORY 4) A 48-year-old woman with a history of excessive intake of alcohol was hospitalized with extreme symptoms of confabulation and received a diagnosis of Korsakoff syndrome. Her memory of recent events was very poor, and she often did not know where she was. She was given a series of tests where she was asked to name and draw images after looking at them. The images were presented at various levels of illumination and sometimes were presented with so little lighting that they could not be seen. However, these invisible pictures did not bother the patient; she confabulated a made-up image whenever she couldn't actually see it and seemed to actually believe that she had seen the things that she was confabulating and drawing. Sometimes, “the patient reported seeing material bearing no relation whatsoever to the visual stimuli presented, and made ready answers without regard to reality” (p. 332). When the pictures could be seen, she completed the tasks successfully. It seemed that whenever she was missing a detail in her mind, she would make something up and just go with it as if it were true (Wyke & Warrington, 1960).
Peripapillary Retinal Haemorrhages in Wernicke’s Encephalopathy Following Bariatric Surgery in a Young Patient
Published in Neuro-Ophthalmology, 2022
Motazz A. Alarfaj, Nada H. Almadhi, Mohammad Al-Amry, Abdullah I. Almater, Majed Al-Obailan
Vitamin B1, or thiamine, is a water-soluble vitamin that functions as a cofactor for energy production. There is a limited intracellular reserve so constant cellular resupply is needed.1 Thiamine deficiency can manifest with two clinical phenotypes: Wernicke-Korsakoff’s syndrome and beriberi. Wernicke’s encephalopathy is characterised classically by a triad of ophthalmoplegia, confusion, and ataxia. Korsakoff’s syndrome (KS) occurs as a late complication of WE and is defined by memory impairment associated with confabulation. KS has a mortality rate of 20% if left untreated. Beriberi may present with congestive cardiac failure (wet beriberi) or polyneuropathy (dry beriberi).1 WE can occur in the setting of poor nutrition or absorption, for example, after bariatric surgery. Whenever there is clinical suspicion, thiamine replacement should be started immediately because of the cognitive consequences of any delay. Herein, we describe a case of WE following laparoscopic sleeve gastrectomy in a young male patient who presented with binocular horizontal diplopia and was found to have preretinal peripapillary haemorrhages.
Confabulations in post-acute and chronic alcoholic Korsakoff’s syndrome: a cross-sectional study conducted in two centres
Published in International Journal of Psychiatry in Clinical Practice, 2022
Erik Oudman, Yvonne Rensen, Roy P. C. Kessels
To be eligible for inclusion, patients had to meet the DSM-5 criteria for Alcohol-induced Major Neurocognitive Disorder (American Psychiatric Association 2013) and be diagnosed as having Korsakoff’s syndrome in accordance with the criteria outlined in Kopelman (2002), which includes evidence of a history of malnutrition or thiamine deficit. All patients were abstinent from alcohol for at least 6 weeks at the time of testing. None of the patients had any evidence of brain pathology other than alcohol use that would account for their memory deficit (e.g., stroke, tumour). None of the patients met the criteria for major depressive disorder. In addition, patients with evidence of other cognitive disorders (agnosia, aphasia or apraxia) were excluded. The data included in this manuscript were obtained as part of clinical routine and stored and analysed anonymously in accordance with the institutional guidelines, the Helsinki Declaration, and the EU General Data Protection Regulation (GDPR).
Low rates of thiamine prescribing in adult patients with alcohol-related diagnoses in the emergency department
Published in The American Journal of Drug and Alcohol Abuse, 2021
Nathan M. Peck, Theodore C. Bania, Jason Chu
Alcohol use disorder (AUD) is a pervasive issue in the United States with recent estimates at a 13.9% twelve-month prevalence for the entire population aged 18 or older (1). AUD is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as an alcohol consumption pattern that produces significant impairment or distress and is diagnosed by identifying specific complications of alcohol use or manifestations of alcohol dependence in a given patient (2). Wernicke encephalopathy and Korsakoff’s psychosis are neurologic disorders that most frequently develop in the setting of AUD and are due to thiamine deficiency (3). Given the common etiology of thiamine deficiency for both Wernicke encephalopathy and Korsakoff’s psychosis, and because patients with Wernicke encephalopathy often progress to Korsakoff’s psychosis, these two conditions are often referenced together as Wernicke-Korsakoff Syndrome (WKS). The prevalence of WKS, based on autopsy, is estimated between 0.8% and 2.8% for the entire population and 12.5% among individuals with AUD (4–6).