It seems so long. When did I last post? friday? Jeez. Well, you know, life. echk.
Kathryn’s party was alright, nothing to write home about, but it was ok. Mostly family, a few friends who were all small-town, small-minds who bitched between themselves and refused to even look at anyone else who was there. Her family’s pretty cool, they like us. Grandma even invited us to stay at their place if ever we’re in town. Somehow the family all assumed that Steve and I were a couple, but we get that occasionally.
As for my own last-remaining grandparent, he’s… ok. Just. We found out that the ‘stroke’ thing that he had last week, was probably brought on by the fact that someone had prescribed him an anti-psychotic drug (Zyprexa – which is normally used to treat schizophrenia), even though he hasn’t been diagnosed with schizophrenia. Or any other form of psychosis, and his mental deficiencies were actually brought on by one of his heart-attacks, and he had stopped breathing for 10 minutes. sigh The drug should not be administered to anyone with blood pressure and heart problems… And he has both. Mum is NOT happy. I’m far from impressed, myself. The other news was that he has a possible diagnosis. “Wernicke-Korsakoff Syndrome” [more info below]. shrug The symptoms seem to fit, and he has had an alcohol problem in his life. I don’t know. Steven seems to be preparing me for the inevitable, and he seems to be be rushing through it. As mum put it the other day “I’m looking down the barrel of three deaths in four months”. So. Yea. I don’t know what else I can say about that right now.
We were offline here for a couple of days. We decided to re-arrange the furniture, and moved the computer, but then we realized that we needed a phone-line extension cord, and yea. We just didn’t get around to getting one for a few days.
Clayton. I ask. Nothing happens. I ask why. Excuses. Oh well. Need I say more? No.
Anyway. Here. Read about
Alternative names
Korsakoff psychosis; Alcoholic encephalopathy; Encephalopathy – alcoholic; Wernicke’s disease
Definition
Wernicke-Korsakoff syndrome is a brain disorder involving loss of specific brain functions caused by a thiamine deficiency.
Causes, incidence, and risk factors
The syndrome is actually a spectrum, including two separate sets of symptoms, one of which tends to start when the other subsides. Wernicke’s encephalopathy involves damage to multiple nerves in both the central nervous system (brain and spinal cord) and the peripheral nervous system (the rest of the body).
It may also include symptoms caused by alcohol withdrawal. The cause is generally attributed to malnutrition, especially lack of vitamin B1 (thiamine), which commonly accompanies habitual alcohol use or alcoholism.
Heavy alcohol use interferes with the metabolism of thiamine, so even in the unusual cases where alcoholics are eating a balanced diet while drinking heavily, the metabolic problem persists because most of the thiamine is not absorbed.
Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke’s symptoms diminish. It involves impairment of memory out of proportion to problems with other cognitive functions.
Patients often attempt to hide their poor memory by confabulating. The patient will create detailed, believable stories about experiences or situations to cover gaps in memory. This is not usually a deliberate attempt to deceive because the patient often believes what he is saying to be true. It can occur whether or not the thiamine deficiency was related to alcoholism and with other types of brain damage.
Korsakoff psychosis involves damage to areas of the brain involved with memory.
Symptoms
- Vision changes
- Double vision
- Eye movements abnormalities
- Eyelid drooping
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Loss of muscle coordination
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Unsteady, uncoordinated walking
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Loss of memory, can be profound
- Inability to form new memories
- Confabulation (making up stories to explain behavior that have little relation to reality)
- Hallucinations
Note: Symptoms that indicate alcohol withdrawal may also be present or may develop.
Signs and tests
- Examination of the nervous/muscular system may show polyneuropathy (damage to multiple nerve systems).
- Reflexes may be decreased (or of abnormal intensity), or abnormal reflexes may be present.
- Testing of gait and coordination indicates damage to portions of the brain that control muscle coordination.
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Muscles may be weak and may show atrophy (loss of tissue mass).
- Examination of the eyes shows abnormalities of eye movement.
- Blood pressure and body temperature measurement may be low.
- Pulse (heart rate) may be rapid.
The person may appear cachectic (malnourished). A nutritional assessment may confirm malnourished state.
- Serum B1 levels may be low.
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Pyruvate is elevated.
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Transketolase activity is decreased.
If the history is significant for chronic alcohol abuse, serum or urine alcohol levels may be elevated (see toxicology screen) and liver enzymes may be elevated.
Other chronic conditions that may cause a thiamine deficiency include the following:
- AIDS
- Hyperemesis gravidarum (continuous nausea and vomiting during pregnancy)
- Thyrotoxicosis (very high thyroid hormone levels)
- Cancers that have spread throughout the body
- Long-term dialysis
- Congestive heart failure, when treated with long-term diuretic therapy
A brain MRI rarely shows changes in the tissue of the brain indicating Wernicke-Korsakoff syndrome.
Treatment
The goals of treatment are to control symptoms as much as possible and to prevent progression of the disorder. Hospitalization is required for initial control of symptoms.
If the person is lethargic, unconscious, or comatose, monitoring and care appropriate to the condition may be required. The airway should be monitored and protected as appropriate.
Thiamine (vitamin B1) may improve symptoms of confusion or delirium, difficulties with vision and eye movement, and muscleincoordination. Vitamin B1 may be given by injection into a vein or a muscle, or by mouth.
Thiamine does not generally improve loss of memory and intellect associated with Korsakoff psychosis.
Total abstinence from alcohol is required to prevent progressive loss of brain function and damage to peripheral nerves. A well-balanced, nourishing diet is recommended.
Nowhere, does it say “treatment with selected anti-psychotic drugs is recomended.” Rarr.