Wernicke-Korsakoff Syndrome: When the Brain Runs on Empty

Wernicke-Korsaoff Syndrome (WKS), colloquially called Wet brain, is a neurological disorder, most often associated with chronic alcoholism or malnutrition. WKS consists of 2 phases

• Acute reversible phase - Wernicke encephalopathy

• Chronic irreversible phase - Korsaoff syndrome

Symptoms we should know

Wernicke’s Encephalopathy - Medical Emergency

• Classic Triad (not always present together):

  • Confusion/disorientation

  • Ataxia : unsteady gait, poor coordination

  • Ophthalmoplegia : abnormal eye movements, nystagmus, double vision

• Other Symptoms:

  • Lethargy, hypothermia, hypotension

  • Untreated cases progress to coma

Korsakoff Syndrome

• Severe Memory Deficits:

  • Anterograde amnesia (unable to form new memories)

  • Retrograde amnesia (loss of past memories)

• Psychiatric Symptoms:

  • Confabulation (making up false memories)

  • Apathy, lack of insight

  • Hallucinations

    
    

Why and how it causes

The main cause of the disorder is thiamine (vitamin B1) deficiency, thus people with poor nutrition can lead to WKS. This can result from several factors such as

• chronic alcohol abuse

• malnutrition

• chronic diseases altering nutrient absorption (eg. AIDS, cancer)

This is because long term alcohol usage can irritates the digestive tract and also interferes with the absorption of thiamine. Poor nutrition also weakens the ability to absorb thiamine from food. WKS can also develop during the first trimester of pregnancy in women with hyeremesis gravidarum (severe vomiting and nausea).

Thiamine (vitamin B1) is essential for glucose metabolism, the brain’s primary energy source. Without adequate thiamine, critical biochemical pathways fail, leading to cellular energy depletion and neuronal dysfunction. The brain relies almost entirely on glucose for energy. Neurons have minimal energy reserves and cannot switch to alternative fuels (e.g, fatty acids) during thiamine deficiency. High metabolic demand areas such as memory circuits degenerate first. Selective death of neurons in mammillary bodies, thalamus, and cerebellum, can lead to irreversible memory and motor deficits.

Management and treatment

Emergency Treatment (Wernicke’s Phase)

• High-dose IV/IM thiamine

• Glucose must not be given before thiamine as it can worsen damage

  
  

Long term management

• Oral thiamine supplements

• Alcohol cessation and nutritional rehabilitation.

• Memory/cognitive therapy (limited recovery in Korsakoff’s).

Wernicke-Korsakoff Syndrome (WKS) is a preventable yet devastating neurological disorder. Its progression from acute Wernicke’s encephalopathy to chronic Korsakoff syndrome underscores the critical importance of early recognition and intervention. For at-risk individuals, prevention, not just treatment, is the ultimate cure.

References

National Library of Medicine (2023) https://www.ncbi.nlm.nih.gov/books/NBK430729/

National Institute on Alcohol Abuse and Alcoholism (2022) https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/wernicke-korsakoff-syndrome

Cleveland Clinic (2022) https://my.clevelandclinic.org/health/diseases/22687-wernicke-korsakoff-syndrome

Assessed and Endorsed by the MedReport Medical Review Board