title: Non-alcoholic Korsakoff syndrome in psychiatric patients with a history of undiagnosed Wernicke's encephalopathy.
abstract: Wernicke's encephalopathy is often undiagnosed, particularly in non-alcoholics. There are very few reports of non-alcoholic patients diagnosed with Korsakoff syndrome in the absence of a prior diagnosis of Wernicke's encephalopathy and no studies of diffusion tensor imaging in non-alcoholic Korsakoff syndrome. We report on three non-alcoholic psychiatric patients (all women) with long-term non-progressive memory impairment that developed after malnutrition accompanied by at least one of the three Wernicke's encephalopathy manifestations: ocular abnormalities, ataxia or unsteadiness, and an altered mental state or mild memory impairment. In neuropsychological examination, all patients had memory impairment, including intrusions. One patient had mild cerebellar vermis atrophy in MRI taken after the second episode of Wernicke's encephalopathy. The same patient had mild hypometabolism in the lateral cortex of the temporal lobes. Another patient had mild symmetrical atrophy and hypometabolism of the superior frontal lobes. Two patients were examined with diffusion tensor imaging. Reduced fractional anisotropy values were found in the corona radiata in two patients, and the uncinate fasciculus and the inferior longitudinal fasciculus in one patient. Our results suggest that non-alcoholic Korsakoff syndrome is underdiagnosed. Psychiatric patients with long-term memory impairment may have Korsakoff syndrome and, therefore, they should be evaluated for a history of previously undiagnosed Wernicke's encephalopathy.
authors: "Specialists in Psychiatry" Medical Center, Yliopistonkatu 33C28, 20100 Turku, Finland; Satakunta Hospital District, Psychiatric Care Division, General Psychiatry Outpatient Clinic, Sairaalantie 3, 28500 Pori, Finland. Electronic address: georgios.nikolakaros@utu.fi.
authors: Georgios
authors: G
authors: Nikolakaros
authors: Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, rak. 9, 20700 Turku, Finland. Electronic address: tuula.ilonen@utu.fi.
authors: Tuula
authors: T
authors: Ilonen
authors: Terveystalo Pulssi Medical Center, Humalistonkatu 9-11, 20100 Turku, Finland; Department of Radiology, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. Electronic address: timo.kurki@terveystalo.com.
authors: Timo
authors: T
authors: Kurki
authors: Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, rak. 9, 20700 Turku, Finland. Electronic address: janina.paju@utu.fi.
authors: Janina
authors: J
authors: Paju
authors: Cognitive Disorders/Dementia Unit, 2nd University Department of Neurology, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", Rimini street, 12462 Athens, Greece. Electronic address: sokpapa@med.uoa.gr.
authors: Sokratis G
authors: SG
authors: Papageorgiou
authors: Division of Neuropsychiatry, Helsinki University Hospital, PL 100, 00029 HUS, Helsinki, Finland. Electronic address: risto.vataja@hus.fi.
authors: Risto
authors: R
authors: Vataja
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D015897:Comorbidity; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D020915:Korsakoff Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography; D014899:Wernicke Encephalopathy / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology* / Q000628:therapy
keywords: Diffusion tensor imaging; Korsakoff syndrome; Neuropsychological tests; Positron-emission tomography; Psychiatric treatment; Wernicke's encephalopathy