🔴WERNICKE syndrome : Acute, CAN : Confusion, Ataxia, Nystagmus
⭕️KORSAKOFF: chronic, 2ndry to Wernicke.
• Alcoholic not getting Vitamin B-1 before glucose. Thiamine: co-factor glucose metabolism
• Glucose worsens thiamine deficiency
• Alcoholic: consuming carbohydrate without thiamine + not able to absorb / store thiamine
• Damage to mammillary bodies more common than thalamic nuclei. Lesions around 3rd & 4 th ventricle. Prerequiductal gray, locus ceruleus, vestibular nuclei and cerebellum
👉🏿 Causes: chronic ETOH, Poor nutrition, Bariatric surgery, Malignancy, HIV, Hemodialysis, Hyperemesis, Anorexia
3. Nystagmus + partial opthalmoplegia w lateral rectus weakness
🔵 WERNICKE : Sudden, Oculomotor abnormalities, including horizontal and vertical nystagmus and partial ophthalmoplegia, lateral rectus palsy, Pupils Ann, sluggish or unequal. Vestibular Abnormality without hearing loss, the oculovestibular reflex may be impaired. Hypothermia, Gait ataxia may result from vestibular / cerebellar, polyneuropathy; gait: slow, wide-based, short steps.
Rx: Thiamine 500 mg infused over 30 min tid for 2-7 d then 250 mg /d IV or IM X 5 d, then oral daily.
▪ Magnesium : essential cofactor in thiamin-dependent metabolism, if low 1 to 2 g IM
or IV q 6 to 8 hrs or magnesium oxide 400 – 800 mg po /d
◾ Thiamine, folic acid, magnesium sulfate should be given. Consider B-12
👉🏿Dietary consult / help
Obviously you are going to read : Uptodate
🔴 KORSAKOFF psychosis: • 80% repeated wernicke’s •Confusion • disorientation • recent memory issues • apathy • Confabulation: Imaginary experiences filling gaps in recent memory due to ant thalamic lesion • Lack of interest / concern / Indifferent • Personality changes • Retro / Antegrade Amnesia, poor attention, tremors, agitation, permanent changes, postural hypotension, syncope, stupor, coma, death.
Rx: rarely gets better. Acetylcholine receptor inhibitors.
Not a medical advice. Read Uptodate. Check dosage. Make this better.