A 62yo male is brought to the ED by his daughter because of his persistent lying. He is a known
alcoholic and has been admitted recently with delirium tremens. On questioning, he denies any
problem with memory. He knows his name and address and states that was at the betting shop
this morning, but his daughter interjects calling him a liar explaining that he was at her home.
What is the most likely dx?
a. Ganser syndrome
b. Cotard syndrome
c. Wernicke’s encephalopathy
d. Korsakoff psychosis
e. Alcohol withdrawal
answer:D
• 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
n.b.
Anterograde amnesia is a loss of the ability to create new memories after the event that caused the amnesia,
leading to a partial or complete inability to recall the recent past,
while long-term memories from before the event remain intact.
Confabulation (verb: confabulate) is a
memory disturbance, defined as the production of fabricated, distorted
or misinterpreted memories about oneself or the world, without the
conscious intention to deceive.
No comments:
Post a Comment