Alcoholic Encephalopathy: A Very Real and Extremely Dangerous Complication of heavy Alcohol Use
(Wernicke-Korsakoff Syndrome)
What is Alcoholic Encephalopathy (Wernicke-Korsakoff Syndrome)?
Alcoholic encephalopathy is a serious complication of alcoholic liver disease usually caused by years of excessive drinking. Alcoholic liver disease does not affect all heavy drinkers, and women may be more susceptible than men. Drunkenness is not essential for the development of the disease.
Alcoholic Encephalopathy is a loss of specific brain function (damage of brain tissue) caused by a thiaminede deficiency. Malnutrition develops as a result of empty calories from alcohol, reduced appetite, and malabsorption (inadequate absorption of nutrients from the intestinal tract). Malnutrition contributes to liver disease.
Alcoholic encephalopathy is actually a spectrum of two separate sets of symptoms (Wernicke symptoms and Korsakoff symptoms) One set of symptoms begins, and just as it starts to subside, the other set of symptoms start.
Wernicke’s symptoms involve damage to the central nervous system (the brain and spinal cord) and the peripheral nervous system (the rest of the body). The symptoms can range from mild to severe and consist of various neurological symptoms including changes in consciousness, changes in reflexes and behavior changes. The symptoms are caused by disorders of the liver that reduce liver function, such as cirrhosis or hepatitis (inflammation), malnutrition and conditions where blood circulation bypasses the liver entirely.
When the liver cannot properly metabolize and detoxify the substances in the body, toxins build up in the bloodstream. One toxin which is particularly damaging to the nervous system is ammonia. Ammonia is produced when proteins break down. A normal liver detoxifies the ammonia but a damaged liver cannot. Many other substances build up too and cause the blood to be full of toxins and they can severely damage the nervous system. Alcoholic encephalopathy involves damage to the multiple nerves in the central nervous system (brain and spinal cord) and the peripheral nervous system (the rest of the body).
Malnutrition is lack of vitamin B1 (thiamine) which is caused by heavy alcohol use and causes encephalopathy. Alcoholism interferes with the metabolism of thiamine. Even when the alcoholic eats a balanced diet while drinking heavily, the metabolic problem remains because the body cannot absorb thiamine. Severe impairment of the memory develops. This is Korsakoff syndrome.
Korsakoff syndrome or Korsakoff psychosis is the impairment of the memory area of the brain, and other cognitive functions. Patients use confabulation (making up detailed, believable stories about situations) to cover gaps in their memory. The patient often believes what he is saying is true.
Symptoms Seen in Alcoholic Encephalopathy:
Loss of appetite
Nausea
Jaundice
Abdominal pain and tenderness
Fever
Ascites (fluid collection in the abdomen)
Confusion
Excessive thirst
Dry mouth
Fatigue
Double vision
Eye movement abnormalities
Eyelid drooping
Loss of muscle coordination (unsteady, uncoordinated walking)
Extreme loss of memory
Confabulation (making up stories to explain gaps in memory or behavior)
Hallucinations
Weak muscles
Portal high blood pressure (high blood pressure within the liver)
Vomiting blood
Symptoms of alcohol withdrawal may also be present or may develop such as: jumpiness or nervousness, shakiness, anxiety, irritability, excitability, rapid emotional changes, depression, fatigue, difficulty thinking clearly, bad dreams, headaches, sweating, nausea, vomiting, loss of appetite, insomnia, paleness, rapid heart beat, enlarged or dilated pupils, clammy skin, tremors, involuntary movements of the eyelids, agitation, fever, convulsions, blackouts.
Without treatment, the symptoms progress steadily until death. With treatment, some symptoms may be controlled and the progression of the disease may be slowed or stopped. Some symptoms, particularly the loss of memory and cognitive skills, may be permanent.
Treatment is to discontinue use of alcohol, eat a high calorie, and high carbohydrate diet to reduce protein breakdown in the body. Vitamins, especially B1 and folic acid, are associated with improvement. An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Management of the complications of chronic liver disease may be needed. If cirrhosis develops, liver transplant may be necessary.
