Wernicke –korsahoff syndrome

الرحيم الرحمن الله بسمMinistry of High

EducationAlmajmaa University College of Medicine

Don by : Mohammed Abdullah Hazazi 3nd year medical student Supervisor Dr. vaseemAssistant Professor of Biochemistry

My Objectives d) Describe thiamine

deficiency and Wernicke –korsahoff syndrome

Overview: • Vitamin B1 ( thiamine ) is water-soluble B-vitamin

• All B vitamins help the body convert food (carbohydrates) into fuel (glucose), which is used to produce energy.

• B vitamins also help the body metabolize fats and protein.

• B complex vitamins are needed for healthy skin, hair, eyes, and liver. They also help the nervous system function properly, and are needed for good brain function.

• Thiamine contains a pyrimidine ring connected to thiazole ring By methylene bridge

• Source: Liver, eggs, rice and whole grain cereal .

CNS function

• brain function: It help in improve memory and concentration and strengthen the nerves.

• The vitamin is used to reduce the progression of multiple sclerosis , Alzheimer’s disease .

• ensures the development of myelin sheaths and aids nerve functioning .

Vitamin B1 (thiamine) deficiency

Dry beriberi: characterized by peripheral neuropathy (demyelination) with resultant atrophy of the muscles of the extremities, foot drop and wrist drop.

Wet beriberi: is marked by High output cardiac failure with flabby four chambered dilated heart and peripheral edema .

Vitamin B1 (thiamine) deficiency

Wernicke's encephalopathy: This condition is characterized by Confusion , Ataxia , Ophthalmoplegia, Nystagmus.

Korsakoff's psychosis: is characterized by Inability to remember new and old information , amnesi , demyelination in limbic system .

Thiamin Deficiency

WERNICKE-KORSAKOFF SYNDROME it is symptom complex of Wernicke disease and the

Korsakoff's psychosis . Causes of deficiency

1 -Chronic alcoholism (MC) + poor diet2 -Polished rice .

3-Post gastrectomy• Pathology : Brain atrophy associated with WKS occurs in

the following regions of the brain; the mamillary bodies, the thalamus, the periaqueductal grey, the walls of the 3rd ventricle, the floor of the 4th ventrical, the cerebellum, and the frontal lobe.

WERNICKE-KORSAKOFF SYNDROME Eye signs : nystagmus, Ophthalmoplegia ,

fixed pupils and, rarely, papilloedema . Ataxia : broad-based gait, cerebellar signs

and vestibular paralysis .Cognitive change : amnestic syndrome

with confabulation, restlessness, stupor and coma .

investigationsmagnetic resonance imaging (MRI) : The acute

lesions of the Wernicke-Korsakoff syndrome in the mammillary bodies, and other medial thalamic

The cerebrospinal fluid (CSF) : normal or shows modest elevation of the protein content.

Measurements of serum thiamine and red blood cell transketolase : reduction in transketolase.

electroencephalographic (EEG) : abnormalities, consisting of diffuse mild to moderate slow activity.

management50 to 200 mg thiamine intravenously

50 to 200 mg thiamine intramuscularly daily until the patient resumes a normal diet.

further management of Wernicke disease involves the use of a balanced diet and all the B vitamins

Summary Vitamin B1 (thiamine) deficiency : Dry beriberi: peripheral neuropathy (demyelination)Wet beriberi: High output cardiac failure Wernicke's encephalopathy: Confusion , Ataxia

Ophtalmoplegia , Nystagmus.Korsakoff's psychosis: Inability to remember new and old

memory .WERNICKE-KORSAKOFF SYNDROME : it is symptom

complex of Wernicke disease and the Korsakoff's psychosis .Management : 50 to 200 mg thiamine .

Questions?

Resources • lippincott's biochemistry 5th edition.

• Adams and Victor's Principles of Neurology, 10th Edition page (1162 – 1167 ) .

• Kumar & Clark's Clinical Medicine, 7th Edition (1174 – 1175 ) .

Thank you