Emergent Care / Stabilization:
Acute Wernicke encephalopathy is a clinical diagnosis, and prompt treatment can produce recovery. The treatment is high-dose thiamine replacement to prevent progression to Korsakoff syndrome.

Diagnosis Overview:
Wernicke-Korsakoff syndrome is a collection of clinical manifestations that result from vitamin B1 (thiamine) deficiency. The acute clinical manifestations of thiamine deficiency are known as Wernicke encephalopathy (WE). The classic clinical triad for diagnosis is confusion, ophthalmoplegia, and ataxia. Korsakoff syndrome occurs due to chronic thiamine deficiency and is an irreversible manifestation of acute symptoms. Most often, this condition is noted in patient populations with inadequate nutrient absorption or intake of thiamine. Wernicke-Korsakoff syndrome can occur from any condition leading to thiamine deficiency. It is most commonly seen in patients with alcohol use disorder, anorexia nervosa and other eating disorders, a history of gastrointestinal surgery, conditions with hyperemesis, and any other condition causing malnutrition.

WE presents with confusion (disorientation, inattention, memory dysfunction), ophthalmoplegia (horizontal and vertical nystagmus), and ataxia (unsteady, wide-based gait with short-spaced steps). Acute WE is a clinical diagnosis, and prompt treatment can produce recovery. The treatment is high-dose thiamine replacement to prevent Korsakoff syndrome.

Korsakoff syndrome, also known as alcohol amnestic disorder, is a late neuropsychiatric manifestation of chronic WE. Memory loss is the most serious effect; the patient usually has severe impairment of short-term memory. Confabulations are also a common characteristic of patients with Korsakoff syndrome. In alcohol use disorder, thiamine deficiency and alcohol's direct neurotoxic effects combine to produce deficits in anterograde and retrograde memory and apathy. Recovery in Korsakoff syndrome patients is uncommon.