Peter R. Martin: Historical Vocabulary of Addiction.
Wernicke-Korsakoff Syndrome
Hector Warnes’ Comment
Peter Martin's vignette is an excellent summary of the successive changes of the definition, etiology and outcome of the syndrome which came to be known as the Wernicke-Korsakoff'. Of the three cases published by Wernicke in 1881 only two were chronic alcoholics. One was a 20- year-old seamstress whose brain stem neurological lesions (which necropsy showed mainly a "polioencephalitis haemorrhagica superioris") were induced by an overdose of sulphuric acid. Wernicke’s accurate clinical observations are still valid (confusional delirium which can lead to a comatose state, gait ataxia, horizontal nystagmus, unequal pupils, lateral rectus and gaze palsies).
Korsakoff published in 1887 and 1890-1891 cases of chronic alcoholics who developed an amnestic syndrome with confabulations (pseudo-reminiscence) and polyneuritis without disturbances of consciousness. At the time Wernicke published his textbook of psychiatry neither Korsakoff nor Wernicke associated the two disorders. Korsakoff's patients suffered amnestic psychosis seen in chronic alcoholics; Wernicke's cases were cases of delirium frequently seen in alcoholics but almost invariably fatal until thiamine was part of the treatment (neuropathic beriberi). It was later discovered, as Peter Martin pointed out, that malnutrition, hyperemesis, malabsorption and multiple deficiencies were involved particularly pyridoxine and pantothenic acid.
It was also found that although different etiological factors caused the same illness mostly Korsakoff's psychosis was due to chronic alcoholism along with malnutrition, polyneuritis, severe gastritis or esophagitis, hepatic failure and an amnestic syndrome. Another related disorder rarely observed in chronic alcoholics were those addicted to red wine in Italy (Marchiafava-Bignami disease) with finding at necropsy of necrosis and demyelination of the corpus callosum and axonal degeneration. More cases who were not chronic alcoholics were found to be associated with Wernicke's encephalopathy (hyperemesis gravidarum, starvation, chronic hemodialysis, pyloric stenosis, cancer chemotherapy, bariatric surgery, disseminated tuberculosis, hepatic failure, gastric malignancy, digitalis poisoning and so on).
The classical textbook on this syndrome was published in its second edition in 1989 after 18 years of its first edition by Victor, Adams and Collins. They observed 245 patients with Wernicke-Korsakoff Syndrome with detailed brain pathological findings of 82 post-mortem cases. In its second edition the authors updated the findings including new cases and outcome of treatment.
The other classical textbook on the subject was published by David W. McCandless in 2009 which encompassed animal studies and metabolic encephalopathies in general. McDowell and LeBlanc published more specifically on the computed tomographic findings in Wernicke-Korsakoff syndrome as well as another publication on imagenology by Chanraud and Bernard in 2015.
References:
Chanraud S, Bernard C. Neuroimagerie de l'alcoolisme chronique. In: Annales Médico-psychologiques. vol. 173, Elsevier; 2015, pp. 249-54.
McCandless DW. Metabolic Encephalopathy. Springer, New York; 2009
McDowell JR, LeBlanc C. Computed Tomographic findings in Wernicke-Korsakoff syndrome. Arch. Neurol 1984;41:453-4.
Korsakoff SS. Über eine besondere Form psychischer Störung kombiniert mit multipler neuritis. Arch. Psychiatr. Bd 21; 1890.
Korsakoff SS. Über Erinnerung-Störungen (Pseudo-reminiscenzen) by poly-neuritischen psychosen. Allgem. Zeitschr. Psychiat. Bd 47; 1891.
Victor M, Adams RD, Collins G. The Wernicke-Korsakoff and related Neurological Disorders due to alcoholism and malnutrition. Philadelphia: F.A. Davis Co; 1989.
Wernicke C. Lehrbuch der Gehirnkrankheiten für Aerzte und Studierende. Kassel Theodor Fisher, Edit. Berlin; 1881, pp. 229-42.
August 5, 2021