Nikolakaros Georgios, Kurki Timo, Myllymäki Arttu, Ilonen Tuula
Satakunta Hospital District, Psychiatric Care Division, General Psychiatry Outpatient Clinic, Pori, Finland.
HUS Medical Imaging Center, Department of Clinical Neurophysiology, Helsinki University Hospital, Helsinki, Finland.
Neuropsychiatr Dis Treat. 2019 May 22;15:1311-1320. doi: 10.2147/NDT.S203513. eCollection 2019.
Wernicke's encephalopathy (WE) and Korsakoff syndrome (KS) are underdiagnosed. The DSM-5 has raised the diagnostic threshold by including KS in the major neurocognitive disorders, which requires that the patient needs help in everyday activities. We report clinical, neuropsychological, and radiological findings from a patient who developed Wernicke-Korsakoff syndrome as a result of alcohol use and weight loss due to major depression. We assess the diagnosis in the context of the scientific literature on KS and according to the DSM-IV and the DSM-5. The patient developed ataxia during a period of weight loss, thus fulfilling current diagnostic criteria of WE. WE was not diagnosed, but the patient partially improved after parenteral thiamine treatment. However, memory problems became evident, and KS was considered. In neuropsychological examination, the Logical Memory test and the Word List test were abnormal, but the Verbal Pair Associates test was normal (Wechsler Memory Scale-III). There were intrusions in the memory testing. The Wisconsin Card Sorting Test was broadly impaired, but the other test of executive functions (difference between Trail Making B and Trail Making A tests) was normal. There was atrophy of the mammillary bodies, the thalamus, the cerebellum, and in the basal ganglia but not in the frontal lobes. Diffusion tensor imaging showed damage in several tracts, including the uncinate fasciculi, the cinguli, the fornix, and the corona radiata. The patient remained independent in everyday activities. The patient can be diagnosed with KS according to the DSM-IV. According to the DSM-5, the patient has major neurocognitive disorders. Extensive memory testing is essential in the assessment of KS. Patients with a history of WE and typical clinical, neuropsychological, and radiological KS findings may be independent in everyday activities. Strict use of the DSM-5 may worsen the problem of Wernicke-Korsakoff syndrome underdiagnosis by excluding clear KS cases that do not have very severe functional impairment.
韦尼克脑病（WE）和科萨科夫综合征（KS）常被漏诊。《精神疾病诊断与统计手册》第五版（DSM - 5）提高了诊断门槛，将KS纳入重度神经认知障碍，这要求患者在日常活动中需要他人帮助。我们报告了一名因饮酒及重度抑郁导致体重减轻而患上韦尼克 - 科萨科夫综合征患者的临床、神经心理学和影像学检查结果。我们依据关于KS的科学文献以及DSM - IV和DSM - 5对该病例进行诊断评估。该患者在体重减轻期间出现共济失调，从而符合当前WE的诊断标准。当时未诊断出WE，但患者经肠胃外注射硫胺素治疗后部分症状有所改善。然而，记忆问题变得明显，于是考虑为KS。在神经心理学检查中，逻辑记忆测试和单词列表测试结果异常，但词语配对联想测试（韦氏记忆量表第三版）结果正常。记忆测试中存在记忆侵入现象。威斯康星卡片分类测试结果广泛受损，但执行功能的其他测试（连线测验B与连线测验A的差值）结果正常。乳头体、丘脑、小脑及基底神经节出现萎缩，但额叶未出现萎缩。弥散张量成像显示包括钩束、扣带束、穹窿和放射冠在内的多条神经束受损。该患者在日常活动中仍能自理。根据DSM - IV，该患者可被诊断为KS。依据DSM - 5，该患者患有重度神经认知障碍。在KS的评估中，广泛的记忆测试至关重要。有WE病史且具有典型临床、神经心理学和影像学KS表现的患者在日常活动中可能能够自理。严格应用DSM - 5可能会使韦尼克 - 科萨科夫综合征漏诊问题恶化，因为它排除了那些没有非常严重功能障碍的明确KS病例。
