1 - Clinical Symptoms, Neuropathology, and Etiology

Abstract

This chapter discusses the clinical symptoms, neuropathology, and etiology of alcoholic Korsakoff's syndrome. In 1881, Carl Wernicke described a neurological syndrome in three patients that included ataxia, optic abnormalities, and confusional state. Six years following the publication of Wernicke's paper, S. S. Korsakoff published the first of a series of reports in which he detailed the amnesic and confabulatory symptoms that often accompanied disorders involving polyneuropathy. Although long-term alcoholism often preceded these mental changes, Korsakoff noted that the symptoms also followed a number of other conditions such as persistent vomiting, typhoid fever, and intestinal obstruction. On the basis of his observations, he concluded that the presence of a substance toxic to the peripheral and central nervous systems must have been the common denominator in his reported cases. Although neither Wernicke nor Korsakoff could be specific with regard to etiology and both seemed unaware that their two syndromes often occurred sequentially in the same patients, their clinical descriptions of the symptomatology were accurate and represented important initial steps in the identification and understanding of the Wernicke–Korsakoff syndrome. The major symptoms of the Wernicke stage include a global confusional state, opthalmoplegia, nystagmus, ataxia, and polyneuropathy of the legs and arms. The Korsakoff patients' anterograde amnesia is the most striking feature of their disorder. They are unable to learn new verbal and nonverbal information from the time of the onset of their illness.