A 47yo man who is a chronic alcoholic with established liver damage, has been brought to the
hospital after an episode of heavy drinking. His is not able to walk straight and is complaining of
double vision and is shouting obscenities and expletives. What is the most likely dx?
a. Korsakoff psychosis
b. Delirium tremens
c. Wernickes encephalopathy
d. Tourettes syndrome
e. Alcohol dependence
answer: C
Wernicke-Korsakoff Syndrome
• alcohol-induced amnestic disorders due to thiamine deficiency
• necrotic lesions: mammillary bodies, thalamus, brainstem
• Wernicke’s encephalopathy (acute and reversible): triad of nystagmus (CN VI palsy), ataxia, and
confusion
• Korsakoff’s syndrome (chronic and only 20% reversible with treatment): anterograde amnesia
and confabulations; cannot occur during an acute delirium or dementia and must persist beyond usual duration of intoxication/withdrawal
• management
Wernicke’s: thiamine 100 mg PO OD x 1-2 wk
Korsakoff’s: thiamine 100 mg PO bid/tid x 3-12 mo
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