Psych · Addiction psychiatry
Alcohol-related brain injury and Korsakoff syndrome
Also known as ARBI · ARBD · Alcohol-related brain damage · Wernicke encephalopathy · Wernicke-Korsakoff syndrome · Korsakoff psychosis · Alcohol-induced amnestic disorder · Thiamine deficiency encephalopathy
Exam-exhaustive fellowship topic on alcohol-related brain injury and Korsakoff syndrome — ARBI umbrella versus Wernicke–Korsakoff continuum, Caine criteria, thiamine prevention and treatment doses with EFNS/RCP regional deltas, MRI support patterns, neuropsychology of diencephalic amnesia and confabulation, differentials from other dementias, acute emergency care, and long-term rehabilitation, capacity, and supported living. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Suspected Wernicke encephalopathy — treat on Caine any two of four features; do not wait for the classic triad
- Oral thiamine alone is inadequate for suspected or established Wernicke encephalopathy — use high-dose parenteral thiamine immediately
- Giving a large glucose load without concurrent thiamine in a malnourished dependent drinker risks precipitating or worsening Wernicke encephalopathy
- Normal CT or even early MRI does not exclude Wernicke — treat on clinical grounds
- Dense anterograde amnesia with confabulation after alcohol/nutrition crisis — assume Korsakoff risk and arrange capacity-aware disposition
- Discharging a person with untreated WE risk or dense amnesia home without collateral, supports, or capacity assessment
- Labelling working-age ARBI as Alzheimer disease without alcohol, nutrition, and thiamine history
Meet the patient
A 52-year-old man is brought to ED after a fall outside a hostel. He is confused, unsteady, thin, and his eyes will not track your finger fully to the left. He has no fever and no focal weakness.[1][5]
The intern books a CT head, sends bloods, and writes "query intoxication, review when sober". A litre of dextrose goes up because the glucose was 3.4.[2][5]
That last decision is one examiner will ask about. He already met the treatment threshold before anyone looked at a scan, and the carbohydrate load went in without cover.[1][2]
Examiners punish three failures on this topic: waiting for the classic Wernicke triad, vague thiamine dosing with no route and intensity, and collapsing every alcohol-related cognitive problem into "Korsakoff" or a primary degenerative dementia.[1][2][5][8]
References16ShowHide
- [1]Caine D, Halliday GM, Kril JJ, et al. Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy. J Neurol Neurosurg Psychiatry, 1997.PMID 9010400
- [2]Galvin R, Bråthen G, Ivashynka A, et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol, 2010.PMID 20642790
- [3]Thomson AD, Cook CC, Touquet R, et al. The Royal College of Physicians report on alcohol: guidelines for managing Wernicke's encephalopathy in the accident and Emergency Department. Alcohol Alcohol, 2002.PMID 12414541
- [4]Day E, Bentham PW, Callaghan R, et al. Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol. Cochrane Database Syst Rev, 2013.PMID 23818100
- [5]Sechi G, Serra A Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol, 2007.PMID 17434099
- [6]Kopelman MD, Thomson AD, Guerrini I, et al. The Korsakoff syndrome: clinical aspects, psychology and treatment. Alcohol Alcohol, 2009.PMID 19151162
- [7]Arts NJ, Walvoort SJ, Kessels RP Korsakoff's syndrome: a critical review. Neuropsychiatr Dis Treat, 2017.PMID 29225466
- [8]Zahr NM, Kaufman KL, Harper CG Clinical and pathological features of alcohol-related brain damage. Nat Rev Neurol, 2011.PMID 21487421
- [9]Harper C The neuropathology of alcohol-related brain damage. Alcohol Alcohol, 2009.PMID 19147798
- [10]Sullivan EV, Pfefferbaum A Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol, 2009.PMID 19066199
- [11]Zuccoli G, Santa Cruz D, Bertolini M, et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol, 2009.PMID 18945789
- [12]Connor JP, Haber PS, Hall WD Alcohol use disorders. Lancet, 2016.PMID 26343838
- [13]Kopelman MD The Korsakoff syndrome. Br J Psychiatry, 1995.PMID 7728359
- [14]Svanberg J, Evans JJ Neuropsychological rehabilitation in alcohol-related brain damage: a systematic review. Alcohol Alcohol, 2013.PMID 23955833
- [15]Wilson K, Halsey A, Macpherson H, et al. The psycho-social rehabilitation of patients with alcohol-related brain damage in the community. Alcohol Alcohol, 2012.PMID 22278316
- [16]Flannery AH, Adkins DA, Cook AM Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU. Crit Care Med, 2016.PMID 27002274