Differences Between Alcoholic and Nonalcoholic Patients With Wernicke Encephalopathy: A Multicenter Observational Study

Chamorro, Antonio-Javier; Rosón-Hernández, Beatriz; Medina-García, José-A.; Muga, Roberto; Fernández-Solà, J; Martín-González, M. Candelaria; Seco-Hernández, Elena; Novo-Veleiro, Ignacio; Suárez-Cuervo, Carlos; Mateos-Díaz, Ana M.; Monte-Secades, Rafael; Machado-Prieto, Begoña; Puerta-Louro, Rubén; Prada-González, Cristina; Fernández-Rial, Álvaro; Sabio-Repiso, Patricia; Vázquez-Vigo, Rocío; Antolí-Royo, Ana-C.; Gomila-Grange, Aina; Felipe-Pérez, Nieves-C.; Sanvisens-Bergé, Arantza; Antúnez-Jorge, Emilia; Fernández-Rodríguez, C.; Alvela-Suárez, Lucía; Fidalgo-Navarro, Alba; Marcos, Miguel; Castro, Joaquín; Gómez, María-A. Polvorosa; Valle-Sánchez, Mario Del; Lopez-Castro, José; González‐Quintela, Arturo; Laso, Francisco‐Javier

doi:10.1016/j.mayocp.2017.02.019

Cited by 52 publications

(40 citation statements)

References 21 publications

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“…In the acute phase of WE, characteristic alterations (enhanced signal intensity in one or more of the structures depicted in Figures 1 and 2 and enumerated in Table 2 ; see also Figure 3 ) appear in approximately half of the cases. 25 , 72 , 73 Therefore, finding these alterations on MRI strongly supports a clinical diagnosis of WE, 25 and when KS is suspected, their presence supports the clinical diagnosis (see also “Definition, diagnosis, and epidemiology” section).…”

Section: Etiology and Pathogenesismentioning

confidence: 59%

“…We have known since the 1960s that in most cases of histopathologically confirmed WE, only an uncharacteristic mental confusion occurs and that the clinical diagnosis of WE can be challenging and may be missed – in some studies even in the majority of cases. 20 – 22 Although the new operational criteria for the clinical diagnosis of WE, established by Caine et al 23 (henceforth referred to as the “Caine criteria”; see Table 1 ), may lead to a remarkable improvement of the clinical diagnosis, 23 – 25 the diagnosis of WE is in essence a histopathological one. 20 , 21 , 26 …”

Section: Historymentioning

confidence: 99%

“…20 – 22 Although the incidence has always been highest in undernourished alcoholics, WE has also been described in patients with hyperemesis gravidarum, starvation, and all kinds of gastrointestinal diseases, more recently also in AIDS and after bariatric surgery. 25 , 48 – 51 …”

Section: Etiology and Pathogenesismentioning

confidence: 99%

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Korsakoff’s syndrome: a critical review

Arts

Walvoort

Kessels

2017

NDT

222

174

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In this review, we present a survey on Korsakoff’s syndrome (KS), a residual syndrome in patients who suffered from a Wernicke encephalopathy (WE) that is predominantly characterized by global amnesia, and in more severe cases also by cognitive and behavioral dysfunction. We describe the history of KS and its definition, its epidemiology, and the lack of consensus criteria for its diagnosis. The cognitive and behavioral symptoms of KS, which include anterograde and retrograde amnesia, executive dysfunction, confabulation, apathy, as well as affective and social-cognitive impairments, are discussed. Moreover, recent insights into the underlying neurocognitive mechanisms of these symptoms are presented. In addition, the evidence so far on the etiology of KS is examined, highlighting the role of thiamine and alcohol and discussing the continuity hypothesis. Furthermore, the neuropathology of KS is reviewed, focusing on abnormalities in the diencephalon, including the mammillary bodies and thalamic nuclei. Pharmacological treatment options and nonpharmacological interventions, such as those based on cognitive rehabilitation, are discussed. Our review shows that thiamine deficiency (TD) is a crucial factor in the etiology of KS. Although alcohol abuse is by far the most important context in which TD occurs, there is no convincing evidence for an essential contribution of ethanol neurotoxicity (EN) to the development of WE or to the progression of WE to KS. Future research on the postmortem histopathological analysis of brain tissues of KS patients is crucial for the advancement of our knowledge of KS, especially for associating its symptoms with lesions in various thalamic nuclei. A necessary requirement for the advancement of studies on KS is the broad acceptance of a comprehensive definition and definite diagnostic criteria. Therefore, in this review, we propose such a definition of KS and draft outlines for prospective diagnostic criteria.

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Section: Etiology and Pathogenesismentioning

confidence: 59%

Section: Historymentioning

confidence: 99%

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Korsakoff’s syndrome: a critical review

Arts

Walvoort

Kessels

2017

NDT

222

174

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“…Wernicke's encephalopathy (WE) is caused by thiamine deficiency ( 1 , 2 , 3 ). Undiagnosed or inadequately treated WE can cause Korsakoff syndrome (KS).…”

Section: Introductionmentioning

confidence: 99%

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity

Nikolakaros¹,

Kurki

Paju

et al. 2018

Front. Psychiatry

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Background: Non-alcoholic Wernicke's encephalopathy and Korsakoff syndrome are greatly underdiagnosed. There are very few reported cases of neuropsychologically documented non-alcoholic Korsakoff syndrome, and diffusion tensor imaging (DTI) data are scarce.Methods: We report clinical characteristics and neuropsychological as well as radiological findings from three psychiatric patients (one woman and two men) with a history of probable undiagnosed non-alcoholic Wernicke's encephalopathy and subsequent chronic memory problems.Results: All patients had abnormal neuropsychological test results, predominantly in memory. Thus, the neuropsychological findings were compatible with Korsakoff syndrome. However, the neuropsychological findings were not uniform. The impairment of delayed verbal memory of the first patient was evident only when the results of the memory tests were compared to her general cognitive level. In addition, the logical memory test and the verbal working memory test were abnormal, but the word list memory test was normal. The second patient had impaired attention and psychomotor speed in addition to impaired memory. In the third patient, the word list memory test was abnormal, but the logical memory test was normal. All patients had intrusions in the neuropsychological examination. Executive functions were preserved, except for planning and foresight, which were impaired in two patients. Conventional MRI examination was normal. DTI showed reduced fractional anisotropy values in the uncinate fasciculus in two patients, and in the corpus callosum and in the subgenual cingulum in one patient.Conclusions: Non-alcoholic Korsakoff syndrome can have diverse neuropsychological findings. This may partly explain its marked underdiagnosis. Therefore, a strong index of suspicion is needed. The presence of intrusions in the neuropsychological examination supports the diagnosis. Damage in frontotemporal white matter tracts, particularly in the uncinate fasciculus, may be a feature of non-alcoholic Korsakoff syndrome in psychiatric patients.

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“…Only about one-third of patients with WE present classically. 4 There is no specific laboratory blood test to diagnose WE. Thiamine level, even if available, does not reflect…”

Section: Discussionmentioning

confidence: 99%

Lessons of the month: Not just morning sickness

Tong

2020

Clinical Medicine

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A 34-year-old woman (gravida 4; para 3) at 17 weeks of pregnancy presented with abnormal behaviour for 3 weeks associated with difficulties in walking. She had been admitted 2 months prior with hyperemesis gravidarum and was also diagnosed with thyrotoxicosis. Vomiting and poor oral intake persisted after discharge. She was euthyroid otherwise. Clinical examination revealed a dehydrated and confused patient. She had nystagmus and ataxic gate. Magnetic resonance imaging of the brain showed symmetrical signal changes of posteromedial part of thalamus. A diagnosis of Wernicke's encephalopathy (WE) was made and intravenous thiamine was given leading to gradual improvement of symptoms. Her thyroid function test normalised without any treatment. WE can occur in severe hyperemesis gravidarum. Prompt recognition of WE and replacement with thiamine is important to prevent neurological sequelae and mortality. Gestational transient thyrotoxicosis, which is self-limiting, is more prominent in patients with hyperemesis gravidarum and requires only symptomatic treatment.

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Differences Between Alcoholic and Nonalcoholic Patients With Wernicke Encephalopathy: A Multicenter Observational Study

Cited by 52 publications

References 21 publications

Korsakoff’s syndrome: a critical review

Korsakoff’s syndrome: a critical review

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity

Lessons of the month: Not just morning sickness

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Differences Between Alcoholic and Nonalcoholic Patients With Wernicke Encephalopathy: A Multicenter Observational Study

Cited by 52 publications

References 21 publications

Korsakoff&rsquo;s syndrome: a critical review

Korsakoff&rsquo;s syndrome: a critical review

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity

Lessons of the month: Not just morning sickness

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Korsakoff’s syndrome: a critical review

Korsakoff’s syndrome: a critical review