Wernicke encephalopathy / Korsakoff syndrome

FACTS

  • etiology of Wernicke korsakoff: severe B1 deficiency often 2/2 heavy etoh use

HPI

  • universal ROS
    • see below
  • risk factors:
    • etoh abuse
    • hyperemesis
    • gastropplication
    • hemodialysis
    • cancer
    • AIDS
    • prolonged TPN
    • starvation

PHYSICAL EXAM

  • universal exam, and
Wernicke Encephalopathy
Korsakoff Syndrome
Classic Triad: confusion, oculomotor dysfunction (96%), gait ataxia (87%) only seen in 1/3 of patients
irreversible personality changes, anterograde amnesia, confabulation

IMAGING

MRI Brain
  • may be normal
  • may also show:
    • Hyperintense T2/FLAIR in medial thalamus, floor of 4th ventricle, periaqueductal gray of MB
    • atrophy of mamillary bodies
A/P
  • immediate high dose IV or IM thiamine (100mg qD x 5d)
    • ensure glucose NOT given before thiamine (glucose increases demand for thiamine)