Alcohol induced neurocognitive impairment (wernicke - korsakoff): A hidden syndrome

Wernicke’s encephalopathy (WE) is an acute neuro-psychiatric syndrome due to inadequate supply of thiamine (vitamin B1) to the brain which leads to significant morbidity and mortality. Although alcohol use is the most common predisposing factor but Wernicke’s encephalopathy can occur in any patient with nutritional deficiency conditions such as hyperemesis gravidarum, hemodialysis, malignancy, use of total parenteral nutrition without adequate thiamine, and abdominal surgery. In a developing country, there are more chances of thiamine deficiency, because of poor intake of nutrients in routine diet due to economic reasons and local customs and cultural practices concerning the processing and cooking of rice and other foodstuffs. The national household survey of drug use in India (2004) found prevalence of alcohol use in about 21.4% of male population between 18-40 age group. Most of the emergency physicians and general practitioners are not well sensitized about neuropsychiatric disorders in patients with alcohol use disorders. Such patients are still under diagnosed. Till date, no such studies are available about treatment of wernicke-korsakoff syndrome in Indian population. Educating clinicians, specially emergency physicians about evaluation and treatment of Wernicke-Korsakoff syndrome is as important as to educate people to eat well balanced, mixed diet containing thiamine rich food as most of these patients receive emergency treatment but are frequently unrecognized. If undiagnosed or inadequately treated, it is likely to proceed to Korsakoff syndrome. Therefore best treatment for Wernicke-Korsakoff syndrome is prompt diagnosis and adequate treatment.