Tuesday, 5 November 2013

Wernickes and Korsakoffs

There is a 70% reduction of thiamine absorption in malnourished patients who are abstaining from drinking alcohol. Absorption is further reduced if these patients continue to drink.

Only 10% of patients present with the classical triad of Wernicke's:
    Ophthalmoplegia - this is usually of the external recti muscles
    Confusion or impairment of the short term memory.
Other symptoms include:
    Gaze palsies
It is important to know this because delayed management or incorrect treatment has a mortality rate of 17%. Incorrect treatment includes giving glucose before thiamine. Of the patients that survive, 85% will have permanent brain damage in the form of Korsakoff’s psychosis and 25% will need long term institutionalisation in order to receive full time care

Korsakoff’s syndrome
- Anterograde amnesia
  This is an inability to formulate new memories - memories prior to the onset of Korsakoff's syndrome remain intact
- The preservation of immediate memory
- The preservation of implicit memory 
     The person is able to learn new motor skills or show an improvement in complex tasks, even if they do not remember learning these skills
-   Confabulation

Korsakoff’s syndrome is also associated with a loss of spontaneity, drive, and emotional expression. The chronic form of this syndrome is known as Korsakoff's psychosis.

It is possible to improve some aspects of short term memory by:
    - Encouraging the patient to stop drinking alcohol
    - Improving the patient’s diet
    - Advising regular vitamin supplements, including thiamine
    - Rehabilitation.

General amnesia is usually irreversible in patients with Korsakoff’s syndrome. Patients can learn to live independently, but most need residential care.

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