INFORMATION ON ENCEPHALOPATHY

Encephalopathy (Wernicke-Korsakoff syndrome) is a brain disorder involving failure of specific brain functions caused by a thiamine deficiency.

CAUSES OF ENCEPHALOPATHY

The syndrome is in fact a range, including two separate sets of symptoms, one of which tends to start when the other subsides. Wernicke's encephalopathy involves injure to multiple nerves in both the central nervous system (brain and spinal cord) and the peripheral nervous system (the rest of the body).

It can also include symptoms caused by alcohol removal. The cause is usually attributed to malnutrition, especially lack of vitamin B1 (thiamine), which generally accompanies habitual alcohol use or alcoholism.

Heavy alcohol use interferes with the metabolism of thiamine, so even in the extraordinary cases where alcoholics are eating a balanced diet while drinking heavily, the metabolic problem persists because most of the thiamine is not absorbed.

Korsakoff syndrome, or Korsakoff psychosis, tends to increase as Wernicke's symptoms diminish. It involves impairment of memory out of proportion to problems with other cognitive functions.
Patients often try to hide their poor memory by confabulating. The patient will create detailed, believable stories about experiences or situations to cover gaps in memory. This is not generally a deliberate attempt to deceive because the patient often believes what he is saying to be true. It can occur whether or not the thiamine deficiency was related to alcoholism and with other types of brain damage.
Korsakoff psychosis involves damage to areas of the brain involved with memory.

SYMPTOMS OF ENCEPHALOPATHY

• Changes in Vision
1) Double vision
2) Eye movements abnormalities
3) Eyelid relaxed

• Loss of muscle management
1) Unsteady, uncoordinated walking
2) Loss of memory, can be deep
3) Inability to form new memories
4) Confabulation (making up stories to explain performance that have little relation to reality)
• Hallucinations

TREATMENT OF ENCEPHALOPATHY

The goals of treatment are to control symptoms as much as possible and to prevent progression of the disorder. Hospitalization is required for initial control of symptoms.
If the person is tired, unconscious, or exhausted, monitoring and care appropriate to the condition may be required. The airway should be monitored and protected as appropriate.

Thiamine (vitamin B1) may have improve symptoms of confusion or delirium, difficulties with vision and eye movement, and muscle in coordination. Vitamin B1 may be given by injection into a vein or a muscle, or by mouth.
Thiamine does not generally improve loss of memory and intellect connected with Korsakoff psychosis.

Total abstinence from alcohol is required to prevent progressive loss of brain function and injure to peripheral nerves. A well-balanced, nourishing diet is suggested.