PSA--Wernicke's Encephalopathy/Korsakoff's Syndrome

Wernicke's Encephalopathy is a condition that has been known to occur in post-gastric bypass patients and in others.  You need to be aware of the condition, what causes it and then do what needs to be done to prevent it.

 

Enough vomiting, not enough nutrient supplementation and the next thing you know, someone can be getting crazy.  And not “crazy" in the colloquial sense, but “crazy" as in a diagnosis of psychosis sense.

 

And, of course, once someone gets to that point, they stop making any sense.  They often refuse to get labwork done, they may refuse to supplement and--once it goes to a Korsakoff’s situation--they really believe that their own invented memories are fact and they cannot connect with reality.  It would be nice if nobody anywhere had to deal with these conditions, but the reality is that there IS a link between the vomiting that accompanies some weight loss surgeries and these syndromes.  Some people who visit here may be dealing with the issue without knowing it.  Once you are sure it isn’t YOU, look around. You might save someone unnecessary electroshock therapy or even return someone to normal life.

 

Anyway, here are the definitions and then a couple of links to some peer-reviewed literature on the topic.

 

 

Wernicke Encephalopathy is a syndrome characterized by ataxia, ophthalmoplegia, confusion, and impairment of short-term memory.  Untreated, it may progress to Korsakoff's Psychosis, coma and death.

 

There are six major symptoms of Korsakoff's syndrome:

1. anterograde amnesia and
2. retrograde amnesia, severe memory loss
3. confabulation, that is, invented memories which are then taken as true due to gaps in memory sometimes associated with blackouts
4. meager content in conversation
5. lack of insight
6. apathy - the patients lose interest in things quickly and generally appear indifferent to change.

 

http://meeting.chestpubs.org/cgi/content/abstract/128/4/453S -a

 

http://www.journals.elsevierhealth.com/periodicals/cursur/ar ticle/PIIS0149794405001017/abstract

 

 Thanks for posting on this, MsCC ..  

  Scary that the gal in the case study was only 4 months out from WLS (RNY) and yet was able to develop it to such a serious degree in that short of a period, apparently due to her chronic vomiting.  Assuming she had no prior history of vomiting during the period before her WLS, that's pretty dang quickly ..  

   Bottom line seems to be:  post-ops, be sure to get your B vits in, esp. thiamine (and make sure they stay down)!   

I don't know where you get your medical definitions from but here is what my medical dictionary says.

Actually  this is how the Encyclopedia and Dictionary of Medicine, Nursing and Allied Health defines Wernike - Korsakoff syndrome:

A disorder of the central nervous system usually associated with chronic alcoholism and nutritional deficiency. Sometimes called cerebral beri-beri because of the severe depletion of vitamin B,or thiamine which is typical of the disorder

It is characterized by a combination of motor and sensory disturbances (Wernike's Encephalopathy or disease) and disordered memory function (Korsakoff syndrome or psychosis) The condition typically has an abrupt onset, manifested by ocular motility, ataxia, diplopia,and horizontal nystagmus.  Many patients are unaware of their unsteady gait and decreased mental acuity and other signs of  cognitive dysfunction

There usually is an immediate improvement in ocular disturbances one vitamin therapy has begun. The ataxia and diminished perceptual function and concept formation show a much slower rate of improvement. Only about one third of those with Korsakoff psychosis can fully recover. The mortality rate for the syndrome may be as high as 17% during the acute phase.  

WTF is the difference where I got it?  There are NUMEROUS sources...

Because your definition is not correct, It is full of foolishness and misinformation. If you are going to post a PSA be factual. If it is an opinion then say whatever you want.

See the difference?

 

Okay...I'll play...what part of my definition is "incorrect," or "full of foolishness and misinformation?"

Because gawd knows, if the wording that comes from, let's say, Merck or the Journal of Clinical Neurology or the Annals of Surgery don't match verbatim what your little nursing book says, they all must be wrong.

You're move, genius...where, exactly, is the foolishness?

OK, I'll play. I  happen to own a Grey's Anatomy and a Merck Manual along with the medical dictionary. I also get various monthly medical publications The only thing I found correct regarding your (6) items of distinction was amnesia. I did not find any of the other 4 items you say. You are just trying to scare newbies with tales of confabulation?  What the hell is that about?  Or did you just make up these 5 thing to describe the signs and symptoms of these illness'? If that's so, you missed the whole symptoms array.

Here, let me help:
Ocular motility= movement of the eyeball resulting from the third cranial nerve (optic nerve) impairment
Ataxia= failure of muscle coordination
diplopia= perception of seeing two objects wile looking at a single item ( double vision)
Horizontal nystagmus= rapid side to side motion of the eyeball
Decreased mental cognition= self explanatory

" You are just trying to scare newbies with tales of confabulation?  What the hell is that about?  Or did you just make up these 5 thing to describe the signs and symptoms of these illness'?"




Making up for what your formal education has failed to provide you is tedious at best, but here we go:


Korsakoff's syndrome may initially cause severe memory loss for recent events. More remote memory seems to be less impaired. Thus, people may be able to interact socially and converse coherently even though they cannot remember anything that happened in the preceding few days, months, or years or even in the preceding few minutes. They tend to make things up (confabulate) rather than admit that they cannot remember.

Source: Merck 
Link:  http://www.merck.com/mmhe/sec06/ch082/ch082c.html

~~~

What is Wernicke-Korsakoff Syndrome?

Wernicke's encephalopathy is a degenerative brain disorder caused by the lack of thiamine (vitamin B1). It may result from alcohol abuse, dietary deficiencies, prolonged vomiting, eating disorders, or the effects of chemotherapy. Symptoms include mental confusion, vision impairment, stupor, coma, hypothermia, hypotension, and ataxia. Korsakoff's amnesic syndrome-a memory disorder-also results from a deficiency of thiamine, and is associated with alcoholism. The heart, vascular, and nervous system are involved. Symptoms include amnesia, confabulation, attention deficit, disorientation, and vision impairment. The main features of Korsakoff's amnesic syndrome are the impairments in acquiring new information or establishing new memories, and in retrieving previous memories. Although Wernicke's and Korsakoff's may appear to be two different disorders, they are generally considered to be different stages of the same disorder, which is called Wernicke-Korsakoff syndrome. Wernicke's encephalopathy represents the "acute" phase of the disorder, and Korsakoff's amnesic syndrome represents the "chronic" phase.      

Source:National Institute of Neurological Disorders and Stroke
Link:  http://www.ninds.nih.gov/disorders/wernicke_korsakoff/werni cke-korsakoff.htm    

~~~~
         

Wernicke-Korsakoff syndrome

Wernicke-Korsakoff syndrome is a brain disorder due to thiamine deficiency.

Causes

Wernicke's encephalopathy and Korsakoff syndrome are believed to be two stages of the same condition.

Wernicke's encephalopathy is caused by damaging changes in the brain, usually due to a lack of vitamin B1 (thiamine).

A lack of vitamin B1 is common in people with alcoholism. Heavy alcohol use affects the breakdown of thiamine in the body. Even if someone who drinks alcohol heavily follows a well-balanced diet, most of the thiamine is not absorbed.

Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke's symptoms go away. Korsakoff psychosis involves damage to areas of the brain involved with memory.

Symptoms

• Inability to form new memories
• Loss of memory, can be severe

• Loss of muscle coordination (ataxia)

• Unsteady, uncoordinated walking

• Making up stories (confabulation)
• Seeing or hearing things that aren't really there (hallucinations)
• Vision changes

• Abnormal eye movements
• Double vision
• Eyelid drooping

Note: There may also be symptoms of alcohol withdrawal.

Source:  US National Library of Medicine and National Institutes of Health
Link:  http://www.nlm.nih.gov/medlineplus/ency/article/000771.htm

~~~~~

I could go on, but I'm bored now.

Here are my new questions:
1--Since my only college science class was Physics for Social Science Majors and I found references--even from the same publisher you SAY you consulted--that support what I wrote about this disease and prove--yet again--that you have no knowledge of the topic at hand, when are you going to "fess up" and admit that you are, as Diana asserted, a home Health Aide instead of a real nurse?

2--Since you are repeatedly presenting with some of the above mentioned behaviors, how are your Thiamine levels?

3--Do you really want newbies to ignore the information I presented because you have never seen a case like this?  Or because you don't like me?  In one of these published articles, the patient was on her way to electroschock therapy when what she needed was vitamin supplementation.  You would wish that on someone?  For chrissakes, woman, there is an entire UNIVERSE of **** you don't know...you want us to not share information you aren't familiar with?  (It ain't gonna happen, but I threw that in for the rhetorical effect.)

Go get your labs redone before you become "Exhibit #1."

Well at least NOW you are actually citing facts. Makes a little more sense that that drivel on the top of the page..

Sweetie, I can be the hospital custodian if that would make you feel superior. Believe whatever you high school drop out little self wants to think I am. I don't need you or Diana to validate  my life or my work.
 
You are some kind of wanna be who never got there and now are mad and bitter about it. I understand Dear. I have seen it many many times. Just keep applying yourself and you will attain that high school diploma yet. Don't give up. maybe Diana can tutor you.  

So this is your way of admitting that you were (as usual) wrong?

You are admitting that I wasn't inventing anything to scare newbies?

You were disputing my facts because you couldn't find them in your little books and didn't bother looking elsewhere?

Confabulation IS a symptom, is it not?

And there is no drivel anywhere that *I* posted.  The only drivel is this:  "Because your definition is not correct, It is full of foolishness and misinformation. If you are going to post a PSA be factual. If it is an opinion then say whatever you want."  And you wrote that.




PS--HS dropout!  LOL I graduated from high school when I was 16.  You remember being 16...back when you were in 8th grade?  And I have more than a little college in my background.  At my college(s)--as opposed to where you got your Home Health Aide certificate--they made sure we knew how to look stuff up.