What Is Wernicke-Korsakoff Syndrome (WKS)?

Without treatment, Wernicke-Korsakoff syndrome can be fatal.

Wernicke-Korsakoff syndrome (WKS) refers to two brain disorders that often happen at the same time. They are Wernicke encephalopathy and Korsakoff syndrome. Your doctor may describe them as two phases of the same disease. The late stage is sometimes called Korsakoff psychosis or Korsakoff amnestic syndrome. The main symptoms are confusion, loss of muscle coordination, and vision problems.

Here is more information that can help give you a clearer understanding of what WKS is as well as its causes, symptoms, treatment, and possible outcomes.

How Serious Is WKS?

You can get WKS when you have very low levels of vitamin B1 (thiamine). Your body uses vitamin B1 to break down glucose, a type of sugar. This gives you energy. If you don’t have enough B1, your brain and nervous system can’t work the way they should.

It’s possible for you to recover from Wernicke encephalopathy. But you need medical care right away. You can reverse the condition if you get help within the first 2 to 3 days of symptoms. However, it can be hard for you or your doctor to spot the condition in time. More than 80% of people with Wernicke encephalopathy also get Korsakoff syndrome.

Alcohol abuse is the most common cause of WKS. It can lead to the low vitamin B1 levels that trigger the disease. If you misuse alcohol, talk to your doctor. She may be able to help you lower your chances of getting WKS.

It’s important to know when your level of vitamin B1 first gets low. Some early signs include:

• Low or no appetite
• Weight loss
• Weakness
• Tiredness

Wernicke encephalopathy, the first and potentially reversible phase of this syndrome, may cause:

• Trouble thinking. You may feel confused or indifferent. You may also be very tired or have trouble paying attention.
• Vision problems. You may see double. Your eyes may move back and forth quickly. Or, your eye muscles could stop moving. Although rare, your eyelids could sag.
• Movement problems. You may not be able to move your muscles very well. You may start to wobble or walk slowly. You could have trouble holding yourself up.

You also may have other physical or mental symptoms such as:

• Low body temperature
• Low blood pressure when you stand up
• Loss of consciousness (coma)
• Bad mood
• Fast heart rate
• Seizures
• Pupils that aren’t the same size

With high-dose thiamine treatment, symptoms of Wernicke encephalopathy may get better in 5 to 12 days. If you don’t get help, your condition will get more serious.

Korsakoff syndrome often comes after Wernicke encephalopathy. A person who has it usually won’t know it. But, people close to the person may notice that he makes things up. People with the syndrome do this to fill in gaps in their memory.

The main symptom of Korsakoff syndrome is memory problems. People may also lose their sense of time. And they may have symptoms of Wernicke encephalopathy, including vision problems and trouble walking.

In addition, they might:

• Lose old memories (amnesia)
• Have trouble remembering new things
• Hear things that aren’t there
• Feel lost or confused

You increase your chances of getting WKS if you drink a lot of alcohol for a long time. That’s because alcohol affects your body’s ability to absorb and use vitamin B1. You may also forget to eat enough food with thiamine when you drink. Some studies suggest your genes might play a role in getting WKS. But researchers haven’t yet reached a consensus on the genetics of the condition.

Very low levels of thiamine for any reason can cause WKS. This can happen when you:

• Throw up for a long time
• Have an eating disorder
• Don’t eat enough food with vitamin B1 (malnutrition)
• Have a mental condition like schizophrenia
• Get gastric bypass surgery
• Have a problem with your digestive tract that prevents it from absorbing vitamins
• Get chemotherapy for cancer
• Have a disease that affects your whole body, such as cancer, AIDS, and some infections
• Have very bad morning sickness (hyperemesis gravidarum)
• Have kidney disease

WKS is a little more common in men than women. A serious form of alcohol withdrawal may trigger Korsakoff psychosis (delirium tremens). Rarely, you may get WKS from a bad head injury.

There isn’t one test for WKS. Your doctor will give you a complete physical exam first. You’ll also answer questions about your health history and lifestyle. You should be honest about how much alcohol you drink and what food you eat.

If your doctor thinks you have Wernicke-Korsakoff syndrome, she may also:

• Test your memory
• Check your thiamine levels
• Give you an eye test
• Look at how you walk

Your doctor will want to rule out other conditions. To do that, he may test your:

• Blood
• Urine
• Liver
• Thyroid
• Electrolyte and vitamin levels

Your doctor may order brain scans to see if you have tumors or bleeds.

If you have both conditions, you need to get care for each one.

Wernicke encephalopathy. Your doctor will give you thiamine right away -- maybe before you have a definite diagnosis. Your health care team will watch you closely to see if you have an allergic reaction.

To get better, you may need to stay in the hospital. That way doctors can give you:

• Shots of thiamine in your muscles
• Thiamine through your veins (IV)
• Fluids to balance your electrolytes
• Good nutrition
• Magnesium and potassium supplements

After your levels are normal, you may need to take a thiamine pill every day.

You may also need to:

• Quit drinking alcohol
• Change your diet
• Get mental health treatment (psychotherapy)
• Get physical therapy

Korsakoff syndrome. Your doctor will try to protect your brain from more harm. She will give you thiamine replacement therapy. But you may also need treatment to stop other symptoms that cause problems in your daily life.

There isn’t any medicine -- yet -- that treats Korsakoff syndrome itself. But your doctor may teach you skills to help with your memory.

How Do You Prevent WKS?

The best way to keep from getting WKS is to eat a healthy diet and limit your alcohol use. But if you drink a lot of alcohol, your doctor may want you to take a thiamine supplement every day. He may give you other vitamins too. If you have a chance of getting Wernicke encephalopathy, your health care provider may give you shots of thiamine to keep you from getting sick.

Your recovery depends on how fast you get treatment. You can return to normal after Wernicke encephalopathy if you get help early. But you may have memory or walking problems that don’t go away. It could take a year for your confusion to get better.

With Korsakoff syndrome, some of your symptoms may improve with treatment. Your vision might improve or go completely back to normal. You may recover from some of the movement and muscle problems, too.

Memory is harder to recover. Only about one in five people get their memory back completely. Others see varying degrees of improvement.

Sometimes the condition continues to progress. You may need someone to care for you. About one in four people do. If you don’t get treatment, Wernicke-Korsakoff syndrome can be fatal.