Korsarkoff’s syndrome-Kennedy Kachingwe.pdf

This presentation provides a comprehensive overview of Korsakoff syndrome, a neurodegenerative condition primarily caused by chronic alcohol abuse. It explores the symptoms, causes, diagnosis, and treatment options for this debilitating disorder. The presentation delves into the cognitive impairments, memory deficits, and confabulation associated with Korsakoff syndrome. Additionally, it discusses the importance of early intervention

1. WERNERKINS-
KORSAKOFF’S SYNDROME


Kennedy kachingwe MHPN

2. Expected Outcome
A broader understanding of what Karsakoff’s syndrome is, its cause,
presentation and management

3. Outline
Definition
Risk factors
Pyschopathology/pathophysiology
Clinical manifestations
Investigations
Management

4. Definition
Korsarkoff’s syndrome is a chronic often irreversible complication
of Wernicke’s encephalopathy due to prolonged deficiency of
Thiamine

5. Risk factors
Chronic Alcoholism
Severe Malnutrition
Malabsorption
Poor diet
Medical conditions Chemotherapy
Severe Kidney disease undergoing regular dialysis
Dextrose infusion especially if low thiamine intake
Hyperemesis gravid rum

6. Thiamine. (vit B1)
Main source-Diet
Small amount by intestinal
bacteria
Not synthesized by body
Absorbed in duodenum
Stored in liver
12 hr. half life
Excreted by kidneys
Glucose metabolism
Metabolize lipids, CHO
Maintain normal amino acids
and neurotransmitters

7. Thiamine deficiency
Decreased thiamine
Impaired glucose metabolism decreased cellular energy
ATP in the brain leaves brain vulnerable

- Hemorrhage and necrosis of the mammillary bodies –Poor memory
-Movement and balance disorder(cerebellum)
- Brainstem and nerve issues - heart rate and breathing (medulla)
- Speech problems- brocca’s area

8. Areas of the brain affected by Thiamine
deficiency

9. Alcohol and thiamine mechanism of action
Alcohol interferes with conversion of thiamine pyrophosphotase 1.
By inhibiting action of thiamine phosphatase synthetase reducing
amount of activated thiamine needed for metabolism leading KS
Prevents absorption of thiamine 2.
inhibiting thiamine transporter 1 in duodenal walls preventing Thiamine
to be transported across enterocytes.
3. Alcohol can cause liver cirrhosis
preventing storage of thiamine in the liver

10. Presentation
Wernicke’s syndrome
Visual problems


Delirium Ataxia
Korsakoff’s syndrome
Memory impairment
retrograde amnesia anterograde amnesia
Confabulation apathy
Change of personality
No insight towards the problem

11. Investigations
Neurogical exam
Fbc
RBS
Lft
Thiamine
Imaging-MRI

12. BIOPSYCHOSOCIAL MANAGEMENT
APPROACH
Wernickene-kossarkoffs’s
Prophylactic
All patients with evidence of chronic
alcoholism and sypmtoms of wernekins-
korsakorff.
Thiamine 50-100mg preferably
parenteral bd X 2/7 or 100mg po. X
14/7
IV given as infusion , stop if any signs
of anaphylaxis
Add multivitamins
Correct electrolytes, hypoglycemia,
infection
Wernickene-kossarkoffs’s
Therapeutic
Thiamine 500mg iv tid. 2-3 days then
250mg daily next 3-5 days given over
30 min in 100ml saline
Thiamine 100mg p.o tid rest of
hospitlisation or outpatient
Multivitamin iv
Replace magnesium
Replace fluid and electrolyte losses
If hypoglycemic -iv thiamine then
dextrose (prevent lactic acidocisis)

13. BIOPSYCHOSOCIAL MANAGEMENT
APPROACH
Korsakoff’s
Thiamine 100mg p.o b.d for
months/years depending on
response
Multi vitamin
Treat co-morbidities
Acetylocholinase inhibitor
contraindication
Hx of hypesensitivity
Addisons dzz
Severe hepatitis

14. BIOPSYCHOSOCIAL MANAGEMENT
APPROACH
Nursing
Anaphylaxis
-bronchospasm
-facial and laryngeal edema
-Hypotension
-LOC
(A,B,C – adrenaline,
antihistamine, hydrocortisone, iv
fluid,)
Orienting to environment
Advocacy - Thiamine rich diet
(wholegrains, meat,legumes,nuts)
-- MDT( dietician, neurologist, pharmacist, social
worker, therapists)
Psychosocial
Cognitive Behavioral therapy
-Abstain from alcohol
-personality change
-community & family coping skill
Language therapy

15. References
Abdou E, Hazell, A,S. (2015) Thiamine Deficiency :an update of
pathophysiologic mechanism and future therapeutic considerations,
Nuerochem Res 40, 350-361
Martin R, Singleton C,K . Hiller-Sturmhofel .(2003) The role of thiamine
deficiency in alcoholic brain disease. Alcohol Res Health;;27(2):134-142
Whitfield C,K,Bourissa w, M,Adamolekun B, Lucien B.G. (2018) Thiamine
deficiency disorders: Diagnosis, prevalence,and a roadmap for global
control programs. Annals of the new York academy of sciences
1430(1),3-43
Pyschiatry:Wernicke-korsarkoff syndrome (2022,May
17).Madmedicine.[video].youtube.http