Wernicke-Korsakoff syndrome despite no alcohol abuse: A summary of systematic reports

Erik Oudman; Jan W Wijnia; Misha J Oey; Mirjam van Dam; Albert Postma

doi:10.1016/j.jns.2021.117482

Wernicke-Korsakoff syndrome despite no alcohol abuse: A summary of systematic reports

J Neurol Sci. 2021 Jul 15:426:117482. doi: 10.1016/j.jns.2021.117482. Epub 2021 May 7.

Authors

Erik Oudman¹, Jan W Wijnia², Misha J Oey², Mirjam van Dam², Albert Postma²

Affiliations

¹ Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands. Electronic address: e.oudman@leliezorggroep.nl.
² Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands.

PMID: 34000679
DOI: 10.1016/j.jns.2021.117482

Abstract

Background: Wernicke-Korsakoff syndrome (WKS) is a neurological disorder typically found in alcohol use disorder. The fact that it also occurs in nonalcoholic patients is less well known and often ignored. For the first time, this review offers a systematic investigation of the frequency and associated features of nonalcoholic WKS in the published literature.

Method: We included 11 recent systematic reports, with a total of 586 nonalcoholic WKS cases following hyperemesis gravidarum (n = 177), cancer (n = 129), bariatric surgery (n = 118), hunger strike (n = 41), soft drink diet in children (n = 33), depression (n = 21), Crohn's disease (n = 21), schizophrenia (n = 15), anorexia nervosa (n = 12), ulcerative colitis (n = 10), and incidental thiamine-deficient infant formula (n = 9).

Findings: Vomiting and extreme weight loss were strong predictors of nonalcoholic WKS in adults. Blurred vision was a common presenting sign in about one-fourth of the patients. The classic triad of WKS is characterized by confusion, ataxia, and eye-movement disorders. All reviewed studies reported high percentages of patients presenting with an altered mental status, while both motor symptoms were variably present.

Interpretation: The foregoing observations led to several important conclusions. First, we can see that nutritional impoverishment leads to profound brain damage in the form of WKS. Second, it seems that physicians are either unaware of or underestimate the risks for nonalcoholic WKS. Physicians must be specifically vigilant in detecting and treating WKS in patients with sudden and severe weight loss and vomiting. Third, lower doses of thiamine frequently lead to chronic Wernicke-Korsakoff syndrome. We noticed that when thiamine treatment for WKS was administered, in many cases doses were too low. In line with proven interventions we therefore recommend a parenteral thiamine treatment of 500 mg 3 times per day in adults.

Keywords: Alcohol; Clinical nutrition; Korsakoff'syndrome; Thiamine; Wernicke's encephalopathy.

Publication types

Review

MeSH terms

Adult
Alcoholism* / complications
Ataxia
Child
Female
Humans
Korsakoff Syndrome* / epidemiology
Korsakoff Syndrome* / etiology
Pregnancy
Thiamine
Thiamine Deficiency*
Wernicke Encephalopathy* / diagnosis
Wernicke Encephalopathy* / etiology
Wernicke Encephalopathy* / therapy

Substances

Thiamine