Overview
Korsakoff’s syndrome is a medical emergency characterised by neurocognitive changes due to thiamine deficiency. It usually affects the memory system of the brain.
Thiamine deficiencies can be due to reduced intake, deficiency due to increased demand or malabsorption. It is commonly seen in people with alcohol abuse.
Epidemiology
- Higher prevalence in those at risk for alcohol abuse/malnutrition/malabsorption
- Higher prevalence in the homeless, older individuals living in isolation, and psychiatric inpatients
Risk Factors
- Alcohol abuse and dependence
- Malignancy
- Malnutrition
- Previous gastrointestinal surgery – may be a risk factor for thiamine malabsorption
- AIDS
Differential Diagnoses
Alcohol withdrawal
- Patients have tachycardia, hypertension, and sweating
- They may have hallucinations and seizures
- There may be a history of chronic alcohol use and sudden withdrawal
Wernicke’s encephalopathy
- Memory problems are not usually significant
- Can progress to Korsakoff’s syndrome
Encephalitis
- Patients may have fevers
- There may be focal neurological deficits
- There may be seizures
Investigations
- Thiamine level followed by therapeutic thiamine trial – should improve symptoms
- Capillary blood glucose – to rule out hypoglycaemia
- FBC – usually normal but there may be leukocytosis in infection
- U&Es – to rule out electrolyte derangements and renal dysfunction
- LFTs – usually elevated if there is chronic alcohol consumption
- Serum ammonia – usually normal unless there is co-existent alcoholic liver disease
- Urine and serum drug toxicology – if drug abuse suspected
Management
- 1st-line: IV thiamine
Patient Advice
- Patients should be educated on alcohol avoidance and should be helped with this
- The patient should be informed about the progression of Wernicke’s encephalopathy to Korsakoff syndrome
Complications and Prognosis
Complications
- Persistent ataxia
- Permanent nystagmus
- Persisting learning difficulties and memory impairment
Prognosis
- For those that develop Korsakoff’s syndrome, 25% of patients require long-term institutionalisation
