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Beyond Alcoholism: Wernicke-Korsakoff Syndrome in Patients With Psychiatric Disorders

McCormick, Laurie M. MD; Buchanan, Judith R. MD; Onwuameze, Obiora E. MD, PhD; Pierson, Ronald K. BS; Paradiso, Sergio MD, PhD

Cognitive & Behavioral Neurology: December 2011 - Volume 24 - Issue 4 - p 209–216
doi: 10.1097/WNN.0b013e31823f90c4
Case Reports

Objective: Wernicke encephalopathy and Korsakoff syndrome (the combined disorder is named Wernicke-Korsakoff syndrome [WKS]) are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism; more recently, it has been recognized in patients who have anorexia nervosa or have undergone bariatric surgery for obesity. However, patients with nutritional deficiencies of any origin are at risk for WKS. We present clinical histories and neuroimaging data on 2 young adults with underlying psychiatric disorders who became malnourished and developed WKS.

Methods: A young woman with bipolar disorder and somatization disorder was hospitalized for intractable vomiting. A young man with chronic paranoid schizophrenia developed delusions that food and water were harmful, and was hospitalized after subsisting for 4 months on soda pop.

Results: Acute, life-threatening Wernicke encephalopathy was confirmed in both patients by brain magnetic resonance imaging showing classic thalamic injury. The patients were left with persistent cognitive and physical disabilities that were consistent with Korsakoff syndrome.

Conclusions: Failure to suspect a vitamin deficiency led to permanent cognitive and physical disabilities that may necessitate lifelong care for these patients. The neuropsychiatric consequences could have been prevented by prompt recognition of their thiamine deficiency.

Department of Psychiatry, Psychiatric Iowa Neuroimaging Consortium, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA

Dr McCormick was supported by NIH Career Development Award MH083879-01. Dr Paradiso was supported by the Edward Mallinckrodt Jr Foundation, the Dana Foundation, and NIH/NIA Career Development Award 5K23AG027837.

The authors declare no conflicts of interest.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.cogbehavneurol.com.

Reprints: Laurie M. McCormick, MD, Department of Psychiatry, Psychiatric Iowa Neuroimaging Consortium, Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, W278 GH, Iowa City, IA 52242 (e-mail: laurie-mccormick@uiowa.edu).

Received February 19, 2010

Accepted September 2, 2011

© 2011 Lippincott Williams & Wilkins, Inc.