What causes Wernicke-Korsakoff Syndrome (WKS)?

Updated: May 16, 2018
  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

The following are associated with Wernicke-Korsakoff syndrome:

  • Chronic alcoholism - There may be a synergistically destructive effect of alcohol and thiamine deficiency that contributes to the Wernicke-Korsakoff syndrome. Alcohol interferes with active gastrointestinal transport, and chronic liver disease leads to decreased activation of thiamine pyrophosphate from thiamine, as well as decreased capacity of the liver to store thiamine. [2, 3, 4]

  • Bariatric surgery - Wernicke encephalopathy can present as early as 2 weeks after surgery; recovery typically occurs within 3-6 months of initiation of therapy but may be incomplete if this syndrome is not recognized promptly and treated (the highest risk is in young women with vomiting) [5, 6]

  • Nutritional deficiency and certain diets [7]

  • Starvation - Persons with anorexia nervosa, [8] schizophrenia, [9] or terminal cancer [10] ; prisoners of war

  • Thiamine-deficient formula [11]

  • Hyperemesis gravidarum - In a study of 49 cases of Wernicke encephalopathy in pregnancy, pregnancy loss attributable to Wernicke encephalopathy was nearly 48% [12]

  • Gastric malignancy, [13, 14] inflammatory bowel disease [15]

  • Intestinal obstruction, including abdominal abscess [16]

  • Plastic surgery - Panniculectomy [17]

  • Systemic diseases - Malignancy, [18, 19] disseminated tuberculosis, acquired immunodeficiency syndrome (AIDS), [20] uremia, stem cell transplantation [21]

  • Iatrogenic - Intravenous hyperalimentation (without thiamine supplementation), refeeding after starvation, chronic hemodialysis [22]

  • Encephalitic infections or infarctions affecting the mammillary bodies or hippocampus Rare reports - Rare reports [23]

  • Infants breastfed by mothers with inadequate intake of thiamine [24]


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