Neurology

Wernicke-Korsakoff syndrome

Wernicke-Korsakoff syndrome is a spectrum of thiamine deficiency: acute Wernicke's encephalopathy is a treatable medical emergency, while Korsakoff's syndrome is a chronic amnesic disorder requiring abstinence support, rehabilitation and tailored long-term care.

Definition

Wernicke-Korsakoff syndrome is the clinical spectrum of brain injury associated with thiamine deficiency. Wernicke's encephalopathy is the acute medical emergency with confusion, ocular-motor abnormalities and ataxia; Korsakoff's syndrome is the chronic amnesic disorder that may follow, with severe short-term memory impairment and possible confabulation.

First principles

Treat the clinical syndrome, not a blood-test result

Wernicke's encephalopathy is a clinical emergency caused by thiamine deficiency and is commonly missed because the full triad is not always present. In a person at risk, confusion, an eye-movement abnormality or ataxia is enough to justify urgent parenteral thiamine while alternative causes are assessed; do not wait for MRI or a thiamine level.

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