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Task 9 Of course, Brain damage
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Taak 9 Of course: a coughDefinition of Korsakoff: An abnormal mental state in which memory and learning are
affected out of all proportion to other cognitive functions in an otherwise alert and
responsive patient resulting from nutritional
depletion: thiamine deficiency.
Kolb & Whishaw, H18 Korsakoff’s syndrome
Korsakoff’s syndrome has six major symptoms that constitute the syndrome:
1. Anterograde amnesia
2. Retrograde amnesia
3. Confabulation, in which patients glibly produce pausible stories about pas events
rather than admit memory loss.
4. Meager content of conversation
5. Lack of insight
6. Apathy
The symptoms of Korsakoff’s syndrome may appear suddenly, within the space of a few
days. The cause is thiamine (vitamin B1) deficiency resulting rom prolonged intake of
large quantities of alcohol. The syndrome, which is usually progressive, can be arrested
by massive doses of vitamin B1 but cannot be reversed. Prognosis is poor, with only
about 20% of patients showing much recovery in a year on a B1 enriched diet. Many
patients demonstrate no recovery even after 10 to 20 years.
The exact effect of the vitamin deficiencdcy on the brain has been somewhat
controversial, current thought is that damage occurs in the medial thalamus and, possibly
in the mammillary bodies of the hypothalamus, as well as there being generalized
cerebral atrophy.
1
, Zahr (2011) Clinical and pathological features of alcohol-related brain damage.
Introduction
The neurological consequences associated with this addictive disorder include hepatic
encephalopathy, Wernicke encephalopathy (WE), Korsakoff syndrome (KS), Marchiafava-
Bignami disease (MBD) and central pontine myelinolysis (CPM). The structural changes to
the brain and functional consequences that occur with
chronic alcohol consumption in the absence of diagnosable neurological concomitants of
alcoholism (that is, in cases of uncomplicated alcoholism) are grouped under the term
‘alcohol-related brain damage’ (ARBD).
The Wernicke-Korsakoff syndrome
Wernicke Encephalopathy (WE) is an acute, potentially reversible neurological disorder
caused by a deficiency in or severe depletion of thiamine (vitamin B1) that can result
from chronic alcoholism, poor nutrition, long-term parenteral feeding or bariatric surgery.
Incidence rates of WE in the general population—on the basis of autopsy findings in
Western countries—range from 0.1-2.8%, but can be as high as 12.5% in patients with
alcoholism.
Such individuals are at a
high risk of thiamine
deficiency because of the
poor diet associated with
their lifestyle, and the fact
that chronic alcoholism
compromises thiamine
absorption from the
gastrointestinal tract,
impairs thiamine storage,
and may reduce the
phosphorylation of thiamine
to its biologically active
form.
When WE is left undiagnosed and untreated, =80% of patients with this condition develop
Karsokoff’s syndrome (KS), a severe,typically permanent neurological disorder
characterized by anterograde amnesia. The term Wernicke-Korsakoff syndrome (WKS) is
used to denote the range of brain and behavioral impairments associated with thiamine
deficiency.
Clinical and psychological features
Clinicians are often taught to diagnose WE on the basis of the presence of the classic
clinical triad of:
1. Ocular motor abnormalities (30%)
2. Cerebellar dysfunction (25%)
3. Altered mental state (80%) such as mental sluggishness, apathy, impaired
awareness of an immediate situation, an inability to concentrate, confusion or
agitation, hallucinations, behavioral disturbances mimicking an acute psychotic
disorder, or coma.
Wernicke encephalopathy (WE) is very difficult to diagnose and is missed in 75- 80% of
routine clinical examinations.
2
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