Wernicke-Korsakoff syndrome not related to alcohol use: a systematic review

Abstract

Thiamine deficiency in the absence of an alcohol-use disorder can cause the full clinical spectrum of WKS, including chronic cognitive impairment and Korsakoff syndrome.

The Whole Spectrum of Alcohol-Related Changes in the CNS: Practical MR and CT Imaging Guidelines for Daily Clinical Use

“…Therefore, for example, up to 81 % of a cohort of patients with Wernicke encephalopathy (see below) did not have a history of alcohol abuse [24]. Differences in the clinical manifestation of the disease depending on whether there is an alcoholic or non-alcoholic genesis have been described [25]. At this point it is vital to remember that the optic nerve and retina are also part of the CNS and alcohol abuse or alcohol-induced hypovitaminosis are suspected of being able to trigger toxic amblyopia (alcohol amblyopia) [26].…”

The role of thiamine as a resuscitator in patients with nonalcoholic medical and CNS disorders

“…Outcomes of 611 patients showed death in 179 cases (29%), complete recovery in 129 cases (21%), moderate to severe cognitive impairment in 66 cases (11%), and improvement with residual symptoms, including cognitive impairment or complete recovery not reported, in 237 cases (39%). 13 There is no consensus about the effective thiamine dose for Wernicke encephalopathy; recommendations are for 500 mg of IV thiamine three times a day for two days followed by 500 mg daily for five days. 12 A lower dose of 200 mg has substantial benefit in non-alcoholics.…”

“…12 It is usually associated with alcoholism but rarely occurs with other conditions, such as post bariatric and other gastrointestinal surgeries, malignancy, AIDS, hyperemesis gravidarum, and malnutrition. 13 Wernicke-Korsakoff encephalopathy, when not related to alcohol, occurs almost twice as frequently in women as in men and has better survival rates in women. 13 Characteristic MRI brain findings on T2 FLAIR images include increased signal or hyper-intensity in the periventricular areas, mammillary bodies, thalami, and oculomotor and vestibular nuclei which correlates with the clinical presentation.…”

“…13 Wernicke-Korsakoff encephalopathy, when not related to alcohol, occurs almost twice as frequently in women as in men and has better survival rates in women. 13 Characteristic MRI brain findings on T2 FLAIR images include increased signal or hyper-intensity in the periventricular areas, mammillary bodies, thalami, and oculomotor and vestibular nuclei which correlates with the clinical presentation. 12 The absence of the radiological findings does not rule out this disease.…”

Wernicke’s Encephalopathy in A Young Adult Affected by T Cell Acute Lymphoblastic Leukemia and Ileotiphlytis with Review of the Literature

“…The natural history of this syndrome presents two different stages: a) the Wernicke's Encephalopathy (WE), the acute phase of the syndrome which needs a prompt treatment by the reintegration of thiamine and b) the Korsackoff's psychosis, considered the chronic evolution of the neurological condition [1]. The majority of the clinical cases are related to a persistent alcoholic abuse [2], but it is not infrequent to find cases nonalcohol dependent [3]. Indeed, some risk factors, such as malnutrition, produce in Central Nervous System (CNS) the pathological alteration typical of the syndrome [4].…”