Korsakov's syndrome

Korsakov's syndrome, also known in medicine as Korsakov's psychosis, is considered a kind of amnestic syndrome. It develops due to vitamin B1 deficiency. Its name was received in honor of a psychiatrist from Russia S. Korsakov.

[1], [2], [3]

Causes Korsakov's syndrome

The reason for the development of this syndrome is an inadequate amount of vitamin B1 in the body. Most often it occurs in those people who abuse alcohol for many years. In addition, Korsakov's syndrome can also be detected in patients with hypoxia or severe brain trauma, due to malnutrition. In rare cases, the disease manifests itself after a surgical operation on the temporal part of the head for the treatment of epilepsy.

[4], [5], [6]

Risk factors

The risk of developing this disease is significantly increased if there are some risk factors. As a rule, they are all related to eating habits and the state of his health:

1. Dialysis.
2. Postponed chemotherapy.
3. Elderly age.
4. Extreme diets.
5. Genetic predisposition.

[7], [8], [9], [10], [11], [12]

Pathogenesis

This syndrome is caused by vitamin B1 vitamin deficiency in the human body. This vitamin is a cofactor of several other enzymes, in particular pyruvate dehydrogenase, transketolase, alpha-ketoglutarate dehydrogenase. When the body lacks vitamin B1, this leads to a strong reduction in the utilization of glucose by neurons and damage to mitochondria.

A decrease in the activity of alpha-ketoglutarate dehydrogenase, as well as a significant energy deficit, leads to the accumulation of glutamate in the human body, and this, in turn, leads to neurotoxic effects.

[13], [14], [15], [16], [17], [18], [19]

Symptoms Korsakov's syndrome

There are six symptoms that are basic for Korsakov's syndrome:

1. Amnesia, which has a fixative nature, that is, a person is not able to remember those events that occurred in the recent past or today. But the memories of childhood and youth remain very good. The patient's memory perfectly preserves all events that occurred before the onset of the syndrome.
2. Disorientation based on amnesia. It affects space, time, as well as the skills that have been received by a person in his entire life. Such people often can not live without the care and care of others.
3. "Imaginary memories" or confabulation - when spaces appear in memory, the patient tries to fill them with invented events. When memories become unlike reality, you can talk about the development of psychosis.
4. A cryptomnesia is a state where events of films or books appear on the spot of memory spaces, replacing present events.
5. Modern events in the patient's memory are replaced by events from his past.
6. A person can not conduct a meaningful conversation.

Syndrome Wernicke-Korsakov

The syndrome of Wernicke-Korsakov is one of the varieties of alcoholic psychosis, which can be chronic or may be manifested by acute alcohol intoxication.

In this syndrome, the patient develops at once two conditions: acute encephalopathy Wernicke and chronic Korsakov's syndrome. Psychiatrists unite them in one disease, as they are very rarely found separately for alcoholism.

The main three symptoms of Wernicke-Korsakov syndrome are the following:

1. Paralysis of the muscles of the eye - ophthalmoplegia.
2. Man does not control his movements - ataxia.
3. The patient's consciousness is confused.

Often people with Wernicke-Korsakov syndrome are strongly inhibited, can not make even the simplest conclusions or think logically. Often they remember all the details from their past, but they can not remember what happened to them a minute ago. If the patient tries to look directly, then his head starts to spin, nausea appears.

[20], [21]

Complications and consequences

It should be understood that brain damage in some cases is irreversible. Even with timely and correct treatment, patients with Korsakov's syndrome will forever remain with fixative memory loss and complications of thinking. About 30-40% of all patients remain disabled.

[22], [23]

Diagnostics Korsakov's syndrome

To make the correct diagnosis it is necessary to carry out diagnostics and differentiation. The basis of the diagnosis is the study of anamnesis (tumors, alcoholism), a thorough study of clinical symptoms.

If the patient has at least one indication indicating a deficiency of vitamin B1, the diagnosis should be made without any doubt. For proper diagnosis, a general blood test and liver function tests are used. Also, the doctor conducts an examination of the patient, examines his memory (conduct tests for remembering words, arbitrary and mechanical memorization).

[24], [25], [26]

Analyzes

The following laboratory tests are carried out:

1. A test for determining the amount of albumin in the blood serum - if its level is too low, then it speaks of malnutrition, violations of the liver and kidneys.
2. The analysis for determining the level of vitamin B1 - is carried out together with a general blood test.
3. A test for the activity of the enzyme transketolase in red blood cells (erythrocytes). If the activity is reduced, then there is a deficiency of vitamin B1 in the body.

[27], [28]

Instrumental diagnostics

In some cases, specialists use instrumental methods to diagnose Korsakov's syndrome:

1. ECG (electrocardiography) - with its help you can see how much the patient's picture changed after taking vitamin B1.
2. CT (computer tomography) - with its help, there are violations in the cerebral cortex, which are often found in the syndrome of Wernicke-Korsakov.
3. MRI (magnetic resonance imaging) - shows atypical for Korsakov's syndrome ischemic and hemorrhagic damage.

Differential diagnosis

It should be understood that this syndrome can occur not only against the background of alcohol dependence. Therefore, it is very important to differentiate from similar syndromes: delirium, dementia and amnestic syndromes, which are not associated with taking alcoholic beverages.

Treatment Korsakov's syndrome

Treatment is carried out permanently, since during therapy it is necessary not only to use medicament preparations, but also to help the psychologist. If the treatment is effective, then the first positive results can be seen not earlier than two years from the start of therapy. Restoring the patient is always a very long process.

In some cases, during the treatment, patients are also offered complex subject-matter training. This is a rehabilitation method and it is called a "disappearing hint". The use of drugs for memory is ineffective. During and after therapy, alcoholic beverages are absolutely prohibited.

Medications

Parenteral administration of glucose. The glucose solution is a detoxification and rehydration agent based on dextrose monohydrate.

Glucose takes part in metabolic processes in the human body, helps to strengthen the recovery and oxidative processes, improve the liver and heart. The solution is injected into the vein at a rate of no more than 7.5 ml per minute. The standard dose for adult patients is up to 3000 ml per day.

For patients with reduced glucose tolerance, decompensated diabetes mellitus, hyperglycaemia, hyperlactacidemia and hyperosmolar coma, it is prohibited to administer the drug. In some cases, the development of adverse effects is possible: thrombophlebitis, hypervolemia, hyperglycemia, bruising, fever, infections, polyuria, allergies.

Vitamins

For the treatment of Korsakov's syndrome, it is necessary to administer vitamin B1 (thiamine) intravenously. To obtain a positive effect of such therapy, it must be performed within 3-12 months (depending on the severity level). In this case, only 20% of cases of memory loss and impaired functions in the brain are reversible.

As a rule, combined injection of B / M and B / V injections with vitamin B1 is applied 3 times a day for 2-3 days. If the patient adequately responds to the therapy, injections continue. To achieve a clinically significant effect, treatment with 1 gram of thiamine is sometimes used.

For long-term maintenance therapy, oral intake of group B vitamins, in particular B1, is used. All these activities must necessarily be combined with proper nutrition.

Thiamine. It is available in the form of a solution for injections and capsules. The daily required dose of vitamin B: for adult men - up to 2.1 mg, for the elderly - up to 1.4 mg, for adult women - up to 1.5 mg, for children - up to 1.5 mg.

Parenteral administration of thiamine usually begins with a small dose. If the patient has been found to have a good tolerance of the drug, the dose is gradually increased. The dosage is prescribed by the attending physician, but usually it is as follows: with injections up to 50 mg every day once every 24 hours. When taking the tablet form: up to 10 mg from one to five times in 24 hours. Duration of admission - up to forty days.

Patients with thiamine intolerance are not allowed to take the drug. Sometimes such symptoms may appear: urticaria, rash, itching, allergies, tachycardia, anaphylactic shock.

Prevention

The best method of preventing this syndrome is a constant control over the content of vitamin B1 and thiamine in the blood serum. It is also important not to abuse alcoholic beverages, to lead a healthy lifestyle, to eat right.

[29], [30], [31], [32]

Forecast

The prognosis of this disease depends very much on the degree of its progression. The sooner the treatment begins, the better the prognosis will be. Korsakov's syndrome without proper therapy often ends in a fatal outcome. As a rule, death comes because of infectious lung diseases, septicemia, irreversible organic brain damage.

If the patient began timely treatment, then improvements occur in the following areas:

1. Vision is restored within a couple of hours or a few days.
2. Coordination of movements improves in a few weeks
3. Consciousness returns to the patient for several weeks.

To restore the mental functions and memory of the patient must completely abandon the use of alcoholic beverages. It is very important to eat in a balanced manner, which will help control the level of normal thiamine levels in the future. It is very important to introduce into your daily diet such products as: peas, rice, lean pork, whole grain bread, milk, oranges.

If treatment was started too late, the prognosis is unfavorable. In 25-40% of cases, patients with Korsakov's syndrome become disabled with behavioral problems and mental retardation. The disease is more severe if it is accompanied by other concomitant diseases of the brain.

[33], [34], [35]