Early Detection of Mental and Motor Symptoms In the Wernicke-Korsakoff Syndrome

The clinical signs of Wernicke encephalopathy most often occur within hours to days before a subsequent hospital admission. Wernicke encephalopathy may be identified by the presence of a delirium in malnourished alcoholic patients who have trouble walking. In these patients the delirium is usually due to vitamin B1 (thiamine) deficiency among other causes, which may be erroneously diagnosed as alcohol withdrawal delirium. In Wernicke delirium the possible loss-of-function mechanisms are proposed to come from microglial activation in the brain.
Other heralding symptoms of vitamin B1 deficiency are the serious infections that are likely to occur. Wernicke-Korsakoff patients who suffered from an infection during the acute phase are at risk of worse neuropsychological outcomes on follow-up. Assessing the final Korsakoff syndrome diagnosis becomes relevant when the patient with suspected Korsakoff syndrome can walk independently again. In an attempt to further understand the overall symptom profile, we proposed a neuropathological correlate for Korsakoff syndrome involving cerebellar neurocognition at brainstem level. The time course of mental symptoms and gait- and balance disturbances is described in more detail.
Muscle weakness in chronic alcoholism may be related to interdependent deficiencies of vitamin D, phosphate, and magnesium. Further research is needed to determine if vitamin D supplementation can improve muscle function in chronic alcoholic myopathy.