Thursday, February 5, 2015

Study group discussion: Wernicke Korsakoff syndrome

Review question:
What triad is present in Wernicke's encephalopathy?

Opthalmoplegia, ataxia and confusion.


What is the treatment?



Intravenous or parenteral route is used.

Do we give glucose before the thiamine or after the thiamine?

Thiamine is to be given ASAP, then glucose and anything should be given after.
Never give glucose before thiamine.

Why won't you give glucose first? The patient is also hypoglycaemic, right? All alcoholics are!

Oh wait. I feel like Biochemistry is involved now. So, we do not give glucose before because... We need thiamine to do something to glucose so we can use it.
Yeah thiamine helps break down glucose.
Thiamine is required for glucose metabolism so if we give glucose first patient will be more depleted of thiamine.. This worsening the condition.

Ok, so what will happen if not appropriately treated? Let's say someone gave glucose before thiamine.. What would happen next?

Progression of disease.

Which is called?

Seizures, coma then death.
Bingo!! Korsakoff psychosis.

So, that's anterograde amnesia. I think retrograde too. Along with confabulation.

Yup! Anterograde in more prominent! Which part of brain damage leads to this?

This would be seen in mammillary bodies!
Yes, the mammillary bodies!!
Diencephalon affected particularly mammillary bodies and thalamus.

Hope it helped!!
You are awesome.
Everyone is awesome! I was catching up on the texts before and wow that was intense.

Since we were talking about Wernicke Korsakoff syndrome.. I have a review question too!

Which symptom doesn't improve even after treatment with Thiamine?


Yes! The memory loss is permanent.

Which sign is the first to recover when you administer Thiamine?

Yes, the nystagmus is the first to recover. So that's how you know Thiamine is working.

Wow. Nice I didn't know that!!


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