title: Need for early diagnosis of mental and mobility changes in Wernicke encephalopathy.
abstract: Korsakoff syndrome is a chronic form of amnesia resulting from thiamine deficiency. The syndrome can develop from unrecognized or undertreated Wernicke encephalopathy. The intra-individual course of Wernicke-Korsakoff syndrome has not been studied extensively, nor has the temporal progression of gait disturbances and other symptoms of Wernicke encephalopathy. Here we present the detailed history of a patient whose acute symptoms of Wernicke encephalopathy were far from stable. We follow his mobility changes and the shifts in his mental status from global confusion and impaired consciousness to more selective cognitive deficits. His Wernicke encephalopathy was missed and left untreated, being labeled as "probable" Korsakoff syndrome. Patients with a history of self-neglect and alcohol abuse, at risk of or suffering with Wernicke encephalopathy, should receive immediate and adequate vitamin replacement. Self-neglecting alcoholics who are bedridden may have severe illness and probably active Wernicke encephalopathy. In these patients, mobility changes, delirium, or impaired consciousness can be an expression of Wernicke encephalopathy, and should be treated to prevent further damage from the neurologic complications of thiamine deficiency.
authors.affiliation: *Lelie Care Group, Slingedael Korsakoff Center, Rotterdam, The Netherlands †Lelie Care Group, Slingedael Korsakoff Center; and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands ‡Atlant Care Group, Nursing Home Markenhof, Beekbergen, The Netherlands §Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands ∥Epidemiological and Social Psychiatric Research institute (ESPRi), Erasmus University Medical Center, Department of Psychiatry; and Parnassia Psychiatric Institute, Rotterdam, The Netherlands.
authors.forename: Jan W
authors.initials: JW
authors.lastname: Wijnia
authors.forename: Erik
authors.initials: E
authors.lastname: Oudman
authors.forename: Esmay L
authors.initials: EL
authors.lastname: Bresser
authors.forename: Ineke J
authors.initials: IJ
authors.lastname: Gerridzen
authors.forename: Albert
authors.initials: A
authors.lastname: van de Wiel
authors.forename: Carla
authors.initials: C
authors.lastname: Beuman
authors.forename: Cornelis L
authors.initials: CL
authors.lastname: Mulder
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000150:complications*; D000647:Amnesia / Q000150:complications*; D003221:Confusion / Q000209:etiology; D042241:Early Diagnosis; D020234:Gait Ataxia / Q000209:etiology; D006801:Humans; D020915:Korsakoff Syndrome / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D013831:Thiamine / Q000627:therapeutic use*; D013832:Thiamine Deficiency / Q000150:complications* / Q000188:drug therapy; D014803:Vitamin B Complex / Q000627:therapeutic use*; D014899:Wernicke Encephalopathy / Q000150:complications* / Q000175:diagnosis*
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine