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Nervenheilkunde 2007; 26(09): 781-786
DOI: 10.1055/s-0038-1626926
Original Article
Schattauer GmbH

Das Wernicke-Korsakow-Syndrom

The Wernicke-Korsakow syndrome
R. H. van Schayck
1   Neurologisches Rehabilitationszentrum, Kliniken Schmieder Stuttgart-Gerlingen
,
M. Hurst
2   Psychiatrische Dienste Thurgau, Münsterlingen, Schweiz
› Author Affiliations
Further Information

Publication History

Eingegangen am: 13 April 2007

Publication Date:
20 January 2018 (online)

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Zusammenfassung

Die Wernicke-Enzephalopathie und das Korsakow-Syndrom sind neuropsychiatrische Erkrankungen, die durch einen Thiamin (Vitamin B1)-Mangel verursacht werden. Die Leitsymptome der Wernicke-Enzephalopathie sind eine Trias aus Ophthalmoplegie, Verwirrtheit und Gangataxie. Typische Zeichen des Korsakow-Syndroms (Korsakow-Psychose) sind Gedächtnisstörung und amnestisches Syndrom. Die Wernicke-Enzephalopathie kann nach Abklingen der Akutsymptomatik in ein Korsakow-Syndrom einmünden. Wegen der klinischen Überschneidung und pathologischen Ähnlichkeit werden sie zum Wernicke-Korsakow-Syndrom zusammengefasst. Die Magnetresonanztomografie (MRT) dient dem Nachweis der typischen bilateralen Läsionen benachbart zum IV. Ventrikel, Aquädukt und III. Ventrikel, zugleich der Suche nach anderen möglichen Ursachen wie Hirninfarkte, Schädel-Hirn-Traumen und Herpes Enzephalitis. Ursache ist meist ein chronischer Alkoholmissbrauch, aber auch andere, nicht Alkohol bedingte Ursachen des Thiaminmangels können zu einer Wernicke-Enzephalopathie führen. Wichtigste medikamentöse Behandlungsmaßnahme ist die sofortige parenterale Gabe von Thiamin (Vitamin B1) und die prophylaktische orale Thiaminsubstitution bei Risikopatienten. Eine Behandlung der Gedächtnisstörungen erfolgt vor allem neuropsychologisch rehabilitativ. Zur medikamentösen Behandlung der schweren Gedächtnisstörungen bestehen nur begrenzte Möglichkeiten.

Summary

Wernicke’s encephalopathy and Korsakow’s syndrome are neuropsychiatric diseases caused by thiamine (vitamin B1) deficiency. Wernicke’s encephalopathy presents with the clinical triad of ophthalmoplegia, confusion and gait ataxia. The Korsakow’s syndrome (Korsakow’s psychosis) commonly refers to memory impairment and amnestic syndrome. As the acute symptoms and signs recedes, some patients with Wernicke’s encephalopathy are left with a Korsakow’s amnestic syndrome. The clinical connection and the pathological similarity between both conditions are recognized as the Wernicke-Korsakow syndrome. Magnetic resonance imaging (MRI) shows the bilateral lesions adjacent to the fourth ventricle, aqueduct, and third ventricle. MRI also demonstrates brain infarctions, traumatic brain damage, and herpes simplex encephalitis in cases of symptomatic Korsakow’s amnestic syndrome. The Wernicke-Korsakow syndrome is commonly associated with chronic alcoholism, but a large number of cases occur in other conditions with thiamine deficiency. First choice of medical treatment is the parenteral application of thiamine (vitamin B1) immediately. Patients at risk are treated by oral thiamine. The severe memory impairment has to be managed with neuropsychological rehabilitation. The effects of medical treatments for the amnestic syndrome are limited.

Schlüsselwörter

Wernicke-Enzephalopathie - Korsakow-Syndrom - Thiamin - Vitamin B1

Keywords

Wernicke’s encephalopathy - Korsakow’s syndrome - thiamine - vitamin B1
 

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