Korsakoff's psychosis

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Korsakoff's syndrome, is due to absolute thiamine deficiency of the cortical neurons and their mileau that depends upon oxidative metabolism, most frequently recognised in alcoholism and resulting in mainly medial diencephalic brain degeneration. It is manifest by:

Those with an initial presentation may have preserved intelligence and short-term memory.

Treatment

Parental, followed by oral B group vitamins, in particular thiamine before any shift to carbohydrate metabolism so as to minimise long term brain damage (ie dementia).

  • Parental B group vitamins should be given before any parental glucose
  • Cases of undertreatment are well described, parental therapy may be needed for an inconvenient period of up to 3 days
  • Oral treatment is insufficient in acute presentations

Physiology

In alcoholics it does not appear that riboflavin (vitamin B2 ) or pyridoxine (vitamin B6 ) deficiency produces Wernicke-Korsakoff syndrome as it is only transketolase that is deficient, not riboflavin-dependent glutathione reductase or pyridoxine-dependent aspartate amino transferase.

See also

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