What is Wernicke-Korsakoff syndrome (WKS)?
Wernicke-Korsakoff syndrome (WKS) is a type of brain disorder caused by a lack of vitamin B-1, or thiamine. The syndrome is actually two separate conditions that can occur at the same time, Wernicke’s disease (WD) and Korsakoff syndrome. Usually, people get the symptoms of WD first. WD is also known as Wernicke’s encephalopathy.
Symptoms of WKS may include confusion, changes to the eyes and vision, or exaggerated storytelling, among others.
Risk factors for WKS are related to your diet and lifestyle.
The major risk factors for developing WKS are malnourishment and chronic alcohol misuse. Other risk factors for WKS include:
The no. 1 cause of WKS is alcoholism.
The less common causes of WKS are conditions that limit nutritional absorption. Eating and nutrient absorption can be restricted by:
- gastric bypass surgery, which makes it difficult to meet nutritional needs due to limited food portions
- gastric cancer, which may limit the absorption of essential nutrients
- colon cancer, which can result in pain that causes you to put off eating
- eating disorders
Alcoholism is the no. 1 cause of WKS because people with the condition generally have a poor diet. Alcohol also prevents vitamin B-1 absorption and storage.
Lesions on the brain cause WD. These lesions are the result of a vitamin B-1 deficiency.
Prominent symptoms of WD are:
- double vision
- a drooping upper eyelid, also known as ptosis
- up-and-down or side-to-side eye movements
- loss of muscle coordination, or ataxia, which may interfere with walking
- a confused mental state, which frequently leads to combativeness or violent behavior
You may also have the following symptoms if you have WKS:
Diagnosing WKS isn’t always easy.
An individual with WKS is often mentally confused. This can make communication with the doctor difficult. Your doctor may overlook the possibility of a physical disorder if you’re confused.
Signs of alcoholism
Your doctor may first check for signs of alcoholism. They may check your blood alcohol levels. Sometimes, they’ll take a liver function test to check for liver damage. Liver damage is a common sign of alcoholism.
Signs of nutritional deficiency
Your doctor will look for clinical signs that point to a vitamin B-1 deficiency. This can involve blood tests that measure thiamine levels and your general nutritional health.
Nutritional tests your doctor may order to make sure you aren’t malnourished include:
- Serum albumin test. This test measures the levels of albumin, a protein in the blood. Low levels of albumin may signal nutritional deficiencies as well as kidney or liver problems.
- Serum vitamin B-1 test. This test checks vitamin B-1 levels in the blood. Enzyme activity in the red blood cells (RBCs) can be tested. Low enzyme activity in the RBCs signals a vitamin B-1 deficiency.
You may also need imaging tests, which can help your doctor find any damage that’s characteristic of WKS. Diagnostic imaging tests for WKS include:
- an electrocardiogram (ECG or (EKG) before and after taking vitamin B-1, which can help your doctor find abnormalities
- a CT scan to check for brain lesions related to WD
- an MRI scan to look for brain changes related to WD
Your doctor may also use a neuropsychological test to determine the severity of any mental deficiencies.
WKS treatment should begin immediately. Prompt treatment may delay or stop disease progression. Treatments are also able to reverse nonpermanent brain abnormalities.
Treatment may first involve hospitalization. At the hospital, you’ll be monitored to ensure your digestive system is absorbing food properly.
The treatment for WKS may include:
- vitamin B-1 given through an intravenous line (IV) in the arm or hand
- vitamin B-1 given by mouth
- a balanced diet to keep vitamin B-1 levels up
- treatment for alcoholism
After diagnosis, your doctor will most likely give you vitamin B-1 intravenously. Fast treatment may reverse many of the neurological symptoms of WKS.
In a small number of cases, treatment of vitamin B-1 deficiency produces a negative reaction. This is more common in people with alcoholism.
Negative reactions to receiving vitamin B-1 may vary, and can include alcohol withdrawal symptoms such as insomnia, sweating, or mood swings. You may also experience hallucinations, confusion, or agitation.
The outlook for WKS is based on how far the disease has advanced.
Receiving early treatment before irreversible damage has occurred will dramatically improve your outlook.
Mortality rates are high if WKS is left untreated. Most deaths are the result of a lung infection, blood poisoning, or irreversible brain damage.
Those who receive fast treatment can see progress in:
- eye problems
- muscle coordination
Abstaining from alcohol allows continued recovery of memory and mental function.