Beyond Alcoholism

Laurie M. McCormick, Judith R. Buchanan, Obiora E. Onwuameze, Ronald K. Pierson, Sergio Paradiso
2011 Cognitive and Behavioral Neurology  
Objective-Wernicke encephalopathy and Korsakoff syndrome (the combined disorder is named Wernicke-Korsakoff syndrome [WKS]) are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism; more recently, it has been recognized in patients who have anorexia nervosa or have undergone bariatric surgery for obesity. However, patients with nutritional deficiencies of any origin are at risk for WKS. We present
more » ... al histories and neuroimaging data on 2 young adults with underlying psychiatric disorders who became malnourished and developed WKS. Methods-A young woman with bipolar disorder and somatization disorder was hospitalized for intractable vomiting. A young man with chronic paranoid schizophrenia developed delusions that food and water were harmful, and was hospitalized after subsisting for 4 months on soda pop. Results-Acute, life-threatening Wernicke encephalopathy was confirmed in both patients by brain magnetic resonance imaging showing classic thalamic injury. The patients were left with persistent cognitive and physical disabilities that were consistent with Korsakoff syndrome. Conclusions-Failure to suspect a vitamin deficiency led to permanent cognitive and physical disabilities that may necessitate lifelong care for these patients. The neuropsychiatric consequences could have been prevented by prompt recognition of their thiamine deficiency. Wernicke encephalopathy (WE), a life-threatening disorder caused by thiamine (vitamin B1) depletion, has historically been associated with a classic triad of acute neurological symptoms: confusion, ataxia, and ophthalmoplegia. Thiamine deficiency disease can affect primarily the central and peripheral nervous systems (dry beriberi) or the cardiovascular system (wet beriberi). When thiamine deficiency affects the nervous system, ocular findings such as ophthalmoplegia and nystagmus have been described as a hallmark of the disorder, affecting about 85% of patients. 1 However, only 15% to 30% of patients present with the complete WE triad, 1,2 and almost 20% of patients who develop persistent confabulatory
doi:10.1097/wnn.0b013e31823f90c4 pmid:22134191 pmcid:PMC3551444 fatcat:m5byh2xkfvbkdkeil6ni7ifq4e