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Wernicke—Korsakoff Syndrome

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Alcohol and the Brain

Abstract

Several specific disorders of the nervous system develop in patients with chronic alcoholism. However, alcoholics are often subject to malnutrition, head trauma, seizures, and a variety of systemic disorders, and it is often difficult to determine the relative contribution of direct and indirect effects of alcohol in the pathogenesis of the alcohol-related neurologic disorders. About a century has passed since Wernicke and Korsakoff separately described components of the syndrome that now bears their names. During that time, we have learned a great deal about the relationship between alcoholism and the Wernicke—Korsakoff syndrome, and effective treatment for the acute phase of the disorder has been developed. Despite these accomplishments, the specific biochemical derangement that produces structural pathology and clinical symptoms characteristic of the Wernicke—Korsakoff syndrome has not been identified.

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References

  1. Wagener HP, Weir J: Ocular lesions associated with postoperative and gestational nutritional deficiency. Am J Ophthalmol 20: 253–259, 1937

    CAS  Google Scholar 

  2. Ecker AD, Woltman HW: Is nutritional deficiency the basis of Wemicke’s disease? Report of a case. JAMA 112: 1794–1796, 1939

    Article  Google Scholar 

  3. Richmond J: Wemicke’s encephalopathy associated with digitalis poisoning. Lancet 1: 344–345, 1959

    Article  PubMed  CAS  Google Scholar 

  4. Drenick EJ, Joven CB, Swendseid ME: Occurrence of acute Wemicke’s encephalopathy during prolonged starvation for the treatment of obesity. N Engl J Med 274: 937–939, 1966

    Article  PubMed  CAS  Google Scholar 

  5. DeReuck JL, Sieben GJ, Sieben-Praet MR, et al: Wernicke’s encephalopathy in patients with tumors of the lymphoid—hemopoietic systems. Arch Neurol 37: 338–341, 1980

    Article  CAS  Google Scholar 

  6. Rimalovski AB, Aronson SM: Pathogenetic observation in Wernicke—Korsakoff encephalopathy. Trans Am Neurol Assoc 91: 29–31, 1966

    Google Scholar 

  7. Fans AA: Wernicke’s encephalopathy in uremia. Neurology 22: 1293–1297, 1972

    Article  Google Scholar 

  8. Nadel AM, Burger PC: Wernicke encephalopathy following prolonged intravenous therapy. JAMA 235: 2403–2405, 1976

    Article  PubMed  CAS  Google Scholar 

  9. Kramer J, Goodman JA: Wernicke’s encephalopathy. Complication of intravenous hyperalimentation. JAMA 238: 2176–2177, 1977

    Article  PubMed  CAS  Google Scholar 

  10. Lopez RI, Collins GH: Wernicke’s encephalopathy. A complication of chronic hemodialysis. Arch Neurol 18: 248–259, 1968

    Article  PubMed  CAS  Google Scholar 

  11. Victor M, Adams RD, Collins GH: The Wernicke—Korsakoff Syndrome. A Clinical and Pathological Study of 245 Patients, 82 with Post-Mortem Examinations (Contemporary Neurology Series, Vol 7 ). Philadelphia, FA Davis, 1971

    Google Scholar 

  12. Wallis WE, Willoughby E, Baker P: Coma in the Wemicke—Korsakoff syndrome. Lancet 2: 400–401, 1978

    Article  PubMed  CAS  Google Scholar 

  13. Lipton JM, Payne H, Garza HR, et al: Thermolability in Wemicke’s encephalopathy. Arch Neurol 35: 750–753, 1978

    Article  PubMed  CAS  Google Scholar 

  14. Ghez C: Vestibular paresis: A clinical feature of Wernicke’s disease. J Neurol Neurosurg Psychiatry 32: 134–139, 1969

    Article  PubMed  CAS  Google Scholar 

  15. Novak DJ, Victor M: Affection of the vagus and sympathetic nerves in alcoholic polyneuropathy. Arch Neurol 30: 273–284, 1974

    Article  PubMed  CAS  Google Scholar 

  16. Malamud N, Skillikorn SA: Relationship between the Wernicke and the Korsakoff syndrome. Arch Neurol Psychiatry 76: 586–596, 1956

    Article  Google Scholar 

  17. Thomson AD, Baker H, Leevy CM: Patterns of 35S-thiamine hydrochloride absorption in the malnourished alcoholic patient. J Lab Clin Med 76: 34–45, 1970

    PubMed  CAS  Google Scholar 

  18. Victor M, Adams RD, Mancall EL: A restricted form of cerebellar cortical degeneration occurring in alcoholic patients. Arch Neurol 1: 579–688, 1959

    Article  Google Scholar 

  19. Fisher CM, Adams RD: Transient global amnesia syndrome. Acta Neurol Scand 40 (Suppl 9): 7–82, 1964

    Google Scholar 

  20. Caronna JJ, Finklestein S: Neurological syndromes after cardiac arrest. Stroke 9: 517–520, 1978

    Article  PubMed  CAS  Google Scholar 

  21. Smith JS, Brandon S: Morbidity from acute carbon monoxide poisoning at three-year follow-up. Br Med J 1: 318–321, 1973

    Article  PubMed  CAS  Google Scholar 

  22. Benson FD, Marsden CD, Meadows JC: The amnesic syndrome of posterior cerebral artery occlusion. Acta Neurol Scand 50: 133–145, 1974

    Article  PubMed  CAS  Google Scholar 

  23. Friedman HM, Allen N: Chronic effects of complete limbic lobe destruction in man. Neurology 19: 679–690, 1969

    Article  PubMed  CAS  Google Scholar 

  24. Sprofkin BE, Sciarra D: Korsakoff’s psychosis associated with cerebral tumors. Neurology 2: 427–434, 1952

    Article  PubMed  CAS  Google Scholar 

  25. Corsellis JAN, Goldberg GJ, Norton AR: “Limbic encephalitis” and its association with carcinoma. Brain 91: 481–496, 1968

    Article  PubMed  CAS  Google Scholar 

  26. Squire LR, Davis HP: The pharmacology of memory: A Neurobiological perspective. Annu Rev Pharmacol Toxicol 21: 323–356, 1981

    Article  PubMed  CAS  Google Scholar 

  27. McEntee WJ, Mair RG: Memory impairment in Korsakoff’s psychosis: A correlation with brain noradrenergic activity. Science 202: 905–907, 1978

    Article  PubMed  CAS  Google Scholar 

  28. McEntee WJ, Mair RG: Memory enhancement in Korsakoff’s psychosis by clonidine: Further evidence for a noradrenergic deficit. Ann Neurol 7: 466–470, 1980

    Article  PubMed  CAS  Google Scholar 

  29. Oliveros JC, Jandali MK, Timsit-Berthier M, et al: Vasopressin in amnesia. Lancet 1: 42, 1978

    Article  PubMed  CAS  Google Scholar 

  30. Blake DR, Dodd MJ, Evans JG: Vasopressin in amnesia. Lancet 1: 608, 1978

    Article  PubMed  CAS  Google Scholar 

  31. LeBoeuf A, Lodge J, Eames PG: Vasopressin and memory in Korsakoff syndrome. Lancet 2: 1370, 1978

    Article  PubMed  CAS  Google Scholar 

  32. Gubler CJ, Fujiwara M, Dreyfus PM (eds): Thiamine. New York, Wiley, 1976

    Google Scholar 

  33. Cooper JR, Pincus JH: The role of thiamine in nervous tissue. Neurochem Res 4: 223–239, 1979

    Article  PubMed  CAS  Google Scholar 

  34. Blass JP: Thiamin and the Wemicke—Korsakoff syndrome, in Briggs MH (ed): Vitamins in Human Biology and Medicine. Boca Raton, Florida, CRC Press, 1981, pp 107–135

    Google Scholar 

  35. Sable HZ, Gubler CJ (eds): Thiamin: Twenty years of progress. Ann NY Acad Sci 378, 1982

    Google Scholar 

  36. Hoyumpa AM Jr: Characterization of normal intestinal thiamin transport in animals and man. Ann NY Acad Sci 378: 337–343, 1982

    Article  PubMed  CAS  Google Scholar 

  37. Spector R: Thiamin homeostasis in the central nervous system. Ann NY Acad Sci 378: 344–354, 1982

    Article  PubMed  CAS  Google Scholar 

  38. Dreyfus PM: The quantitative histochemical distribution of thiamine in normal rat brain. J Neurochem 4: 183–190, 1959

    Article  PubMed  CAS  Google Scholar 

  39. Pincus JH, Grove 1: Distribution of thiamine phosphate esters in normal and thiamine-deficient brain. Exp Neurol 28: 477–483, 1970

    Article  PubMed  CAS  Google Scholar 

  40. Balaghi M, Pearson WN: Tissue and intracellular distribution of radioactive thiamine in normal and thiamine deficient rats. J Nutr 89: 127–142, 1966

    PubMed  CAS  Google Scholar 

  41. Elsas LJ II, Danner DJ: The role of thiamin in maple syrup urine disease. Ann NY Acad Sci 378: 404–421, 1982

    Article  PubMed  CAS  Google Scholar 

  42. Barchi RL: The nonmetabolic role of thiamine in excitable membrane function, in Gubler CJ, Fujiwara M, Dreyfus PM (eds): Thiamine. New York, Wiley, 1976, pp 283–310

    Google Scholar 

  43. Eder L, Hirt L, Dunant Y: Possible involvement of thiamine in acetylcholine release. Nature 264: 186–188, 1976

    Article  PubMed  CAS  Google Scholar 

  44. von Murait A: The role of thiamine in neurophysiology. Ann NY Acad Sci 98: 499–507, 1962

    Google Scholar 

  45. Armett CJ, Cooper JR: The role of thiamine in nervous tissue: Effect of antimetabolites of the vitamin on conduction in mammalian nonmyelinated nerve fibers. J Pharmacol Exp Ther 148: 137–143, 1965

    PubMed  CAS  Google Scholar 

  46. Eichenbaum JW, Cooper JR: Restoration by thiamine of the action potential in ultraviolet irradiated nerves. Brain Res 32: 258–260, 1971

    Article  PubMed  CAS  Google Scholar 

  47. von Murait A: Thiamine and peripheral neurophysiology, in Harris RS, Thimann KV (eds): Vitamins and Hormones. New York, Academic Press, 1947, pp 93–116

    Google Scholar 

  48. Itokawa Y, Cooper JR: Ion movements and thiamine in nervous tissue. I. Intact nerve preparations. Biochem Pharmacol 19: 985–992, 1970

    Article  CAS  Google Scholar 

  49. Cooper JR, Roth RH, Kini MM: Biochemical and physiological function of thiamine in nervous tissue. Nature 199: 609–610, 1963

    Article  PubMed  CAS  Google Scholar 

  50. Itokawa Y, Schulz RA, Cooper JR: Thiamine in nerve membranes. Biochim Biophys Acta 266: 293–299, 1972

    Article  PubMed  CAS  Google Scholar 

  51. Berman K, Fishman RA: Thiamine phosphate metabolism and possible coenzyme-independent functions of thiamine in brain. J Neurochem 24: 457–465, 1975

    Article  PubMed  CAS  Google Scholar 

  52. Dreyfus PM, Victor M: Effects of thiamine deficiency on the central nervous system. Am J Clin Nutr 9: 414–425, 1961

    PubMed  CAS  Google Scholar 

  53. Rinehart JF, Friedmann M, Greenberg LD: Effect of experimental thiamine deficiency on the nervous system of the rhesus monkey. Arch Pathol 48: 129–139, 1949

    CAS  Google Scholar 

  54. Troncoso JC, Johnston MV, Hess KM, et al: Model of Wernicke’s encephalopathy. Arch Neurol 38: 350–354, 1981

    Article  PubMed  CAS  Google Scholar 

  55. Brody IA, Wilkins RH: Wernicke’s encephalpathy. Arch Neurol 19: 228–232, 1968

    Article  PubMed  CAS  Google Scholar 

  56. DeWardener HE, Lennox B: Cerebral beriberi (Wernicke’s encephalopathy). Review of 52 cases in a Singapore prisoner-of-war hospital. Lancet 1: 11–17, 1947

    Article  PubMed  CAS  Google Scholar 

  57. Phillips GB, Victor M, Adams RD, et al: A study of the nutritional defect in Wernicke’s syndrome: The effect of a purified diet, thiamine, and other vitamins on the clinical manifestations. J Clin Invest 31: 859–871, 1952

    Article  PubMed  CAS  Google Scholar 

  58. Victor M, Adams RD: On the etiology of the alcoholic neurologic diseases with special reference to the role of nutrition. Am J Clin Nutr 9: 379–397, 1961

    PubMed  CAS  Google Scholar 

  59. Henderson G, Schenker S: Cerebral metabolic abnormalities in thiamine deficiency, in Rothschild MA, Oratz M, Schreiber SS: Alcohol and Abnormal Protein Biosynthesis. New York, Pergamon Press, 1975, pp 449–456

    Google Scholar 

  60. Dreyfus PM: Thiamine-deficiency encephalopathy: Thoughts on its pathogenesis, in Gubler CJ, Fujiwara M, Dreyfus PM (eds): Thiamine. New York, Wiley, 1976, pp 229–243

    Google Scholar 

  61. Schenker S, Henderson GI, Hoyumpa AM, et al: Hepatic and Wemicke’s encephalopathies: Current concepts of pathogenesis. Am J Clin Nutr 33: 2719–2726, 1980

    PubMed  CAS  Google Scholar 

  62. Thomson AD: Alcohol related structural brain changes. Br Med Bull 38: 87–94, 1982

    PubMed  CAS  Google Scholar 

  63. Hakim AM, Pappius HM: The effect of thiamine deficiency on local cerebral glucose utilization. Ann Neurol 9: 334–339, 1981

    Article  PubMed  CAS  Google Scholar 

  64. Pincus JH, Wells K: Regional distribution of thiamine-dependent enzymes in normal and thiamine-deficient brain. Exp Neurol 37: 495–501, 1972

    Article  PubMed  CAS  Google Scholar 

  65. McCandless DW, Schenker S: Encephalopathy of thiamine deficiency: Studies of intracerebral mechanisms. J Clin Invest 47: 2268–2280, 1968

    Article  PubMed  CAS  Google Scholar 

  66. McCandless DW, Cassidy CE: Adenine nucleotides in thiamine deficient rat brain. Res Commun Chem Pathol Pharmacol 14: 579–582, 1976

    PubMed  CAS  Google Scholar 

  67. McCandless DW, Curley AD, Cassidy CE: Thiamine deficiency and the pentose phosphate cycle in rats: Intracerebral mechanisms. J Nutr 106: 1144–1151, 1976

    PubMed  CAS  Google Scholar 

  68. Smith E: The turnover of myelin in the adult rat. Biochim Biophys Acta 164: 285–293, 1968

    Article  PubMed  CAS  Google Scholar 

  69. Blass JP, Gibson GE: Abnormality of a thiamine-requiring enzyme in patients with WemickeKorsakoff syndrome. N Engl J Med 297: 1367–1370, 1977

    Article  PubMed  CAS  Google Scholar 

  70. Itokawa Y, Cooper J: Ion movements and thiamine. II. The release of the vitamin from membrane fragments. Biochim Biophys Acta 196: 274–284, 1970

    Article  PubMed  CAS  Google Scholar 

  71. Perri V, Sacchi O, Casella C: Nervous transmission in the superior cervical ganglion of the thiamin-deficient rat. Q J Exp Physiol 55: 25–35, 1970

    PubMed  CAS  Google Scholar 

  72. Gibson G, Barclay L, Blass J: The role of the cholinergic system in thiamin deficiency. Ann NY Acad Sci 378: 382–403, 1982

    Article  PubMed  CAS  Google Scholar 

  73. Terry RD, Davies P: Dementia of the Alzheimer’s type. Ann Rev Neurosci 3: 77–95, 1980

    Article  PubMed  CAS  Google Scholar 

  74. Ito M: Recent advances in cerebellar physiology and pathology, in Kark RAP, Rosenberg RN, Schut LJ (eds): The Inherited Ataxias (Advances in Neurology, Vol 21 ). New York, Raven Press, 1978, pp 59–84

    Google Scholar 

  75. Chan-Palay V, Plaitakis A, Nicklas WJ, et al: Autoradiographic demonstration of loss of labeled indoleamine axons in the cerebellum of chronic diet-induced thiamine deficiency. Brain Res 138: 380–384, 1977

    Article  PubMed  CAS  Google Scholar 

  76. Plaitakis A, Hwang EC, Van Woert MH, et al: Effect of thiamin deficiency on brain neurotramitter systems. Ann NY Acad Sci 378: 367–381, 1982

    Article  PubMed  CAS  Google Scholar 

  77. Hamel E, Butterworth RF, Barbeau A: Effect of thiamine deficiency on levels of putative amino acid transmitters in affected regions of the rat brain. J Neurochem 33: 575–577, 1979

    Article  PubMed  CAS  Google Scholar 

  78. Redos JD, Catravas GN, Hunt WA: Ethanol-induced depletion of cerebellar guanosine 3’,5’-cyclic monophosphate. Science 193: 58–59, 1976

    Article  PubMed  CAS  Google Scholar 

  79. Biggio G, Brodie BB, Costs E, et al: Mechanisms by which diazepam, muscimol, and other drugs change the content of cGMP in cerebellar cortex. Proc Natl Acad Sci USA 74: 3592–3596, 1977

    Article  PubMed  CAS  Google Scholar 

  80. Chan-Palay V, Nilaver G, Palay SL, et al: Chemical heterogeneity in cerebellar Purkinje cells: Existence and coexistence of glutamic acid decarboxylase-like and motilin-like immunoreactivities. Proc Natl Acad Sci USA 78: 7787–7791, 1981

    Article  PubMed  CAS  Google Scholar 

  81. Chan-Palay V, Lin C-T, Palay S, et al: Taurine in the mammalian cerebellum: Demonstration by autoradiography with [3H1 taurine and immunocytochemistry with antibodies against the taurine-synthesizing enzyme, cysteine-sulfinic acid decarboxylase. Proc Natl Acad Sci USA 79: 2695–2699, 1982

    Article  PubMed  CAS  Google Scholar 

  82. Chan-Palay V, Palay SL, Wu J-Y: Sagittal cerebellar microbands of taurine neurons: Immunocytochemical demonstration by using antibodies against the taurine-synthesizing enzyme cysteine sulfinic acid decarboxylase. Proc Natl Acad Sci USA 79: 4221–4225, 1982

    Article  PubMed  CAS  Google Scholar 

  83. Garson JA, Beverley PCL, Coakham HB, et al: Monoclonal antibodies against human T lymphocytes label Purkinje neurones of many species. Nature 298: 375–377, 1982

    Article  PubMed  CAS  Google Scholar 

  84. Caddy KWT, Patterson DL, Biscoe TJ: Use of the UCHTI monoclonal antibody to explore mouse mutants and development. Nature 300: 441–443, 1982

    Article  PubMed  CAS  Google Scholar 

  85. McDowell JR, LeBlanc HJ: Computed tomographic findings in Wernicke-Korsakoff syndrome. Arch Neurol 41: 453–454, 1984

    Article  PubMed  CAS  Google Scholar 

  86. Martin PR, Weingartner H, Gordon EK et al: Central nervous system catecholamine metabolism in Korsakoff’s psychosis. Ann Neurol 15: 184–187, 1984

    Article  PubMed  CAS  Google Scholar 

  87. McEntee WJ, Mair RG, Langlais PJ: Neurochemical pathology in Korsakoff’s psychosis: Implications for other cognitive disorders. Neurology 34: 648–652, 1984

    Article  PubMed  CAS  Google Scholar 

  88. Martin PR, Higa S, Bums RS et al: Decreased 6-hydroxymelatonin excretion in Korsakoff’s psychosis. Neurology 34: 966–968, 1984

    Article  PubMed  CAS  Google Scholar 

  89. Sharp FR, Bolger E, Evans K: Thiamine deficiency limits glucose utilization and glial proliferation in brain lesions of symptomatic rats. J Cereb Blood Flow Metabol 2: 203–207, 1982

    Article  CAS  Google Scholar 

  90. Sharp FR, Evans K, Bolger E: Local cerebral glucose utilization in the symptomatic thiamine-deficient rat: Increases in fornix and pyramidal tract. Neurology 32: 808–814, 1982

    Article  PubMed  CAS  Google Scholar 

  91. Hakim AM, Pappius HM: Sequence of metabolic, clinical, and histological events in experimental thiamine deficiency. Ann Neurol 13: 365–375, 1983

    Article  PubMed  CAS  Google Scholar 

  92. Witt ED, Goldman-Rakic PS: Intermittent thiamine deficiency in the rhesus monkey. I. Progression of neurological signs and neuroanatomical lesions. Ann Neurol 13: 376–395, 1983

    Article  PubMed  CAS  Google Scholar 

  93. Witt ED, Goldman-Rakic PS: Intermittent thiamine deficiency in the rhesus monkey. II. Evidence for memory loss. Ann Neurol 13: 396–401, 1983

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Departments of Neurology, Pharmacology, and Pediatrics, University of California, San Francisco, and Ernest Gallo Clinic and Research Center, San Francisco General Hospital, San Francisco, California, 94110, USA

    David A. Greenberg & Ivan Diamond

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  1. David A. Greenberg
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  2. Ivan Diamond
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Editors and Affiliations

  1. Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 15213, Pittsburgh, Pennsylvania, USA

    Ralph E. Tarter Ph.D.

  2. Department of Medicine, Division of Gastroenterology, University of Pittsburgh School of Medicine, 15261, Pittsburgh, Pennsylvania, USA

    David H. van Thiel M.D.

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Greenberg, D.A., Diamond, I. (1985). Wernicke—Korsakoff Syndrome. In: Tarter, R.E., van Thiel, D.H. (eds) Alcohol and the Brain. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-9134-1_12

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  • DOI: https://doi.org/10.1007/978-1-4757-9134-1_12

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