Wernicke-Korsakoff Syndrome Differential Diagnoses

Updated: May 16, 2018
  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD  more...
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DDx

Diagnostic Considerations

Wernicke encephalopathy should be differentiated from acute delirium secondary to hypoxia, hypercarbia, central nervous system (CNS) infections, and postictal state (seizure). Ataxic disorders also can result from cerebellar infarction. Ocular disorders also can result from vasculitis or infarction.

Several recent review papers have suggested routinely incorporating the Caine criteria, proposed in 1997. Because the classic textbook symptoms are rare and because the potentially treatable disorder is so often missed, these criteria may provide significant value in the general hospital and psychiatric hospital setting. [36]

These criteria suggest that a diagnosis of Wernicke encephalopathy can be made if 2 of the following are present in a patient with chronic alcoholism:

  • Eye signs (ocular abnormalities as described above)

  • Cerebellar signs (ataxia as described above)

  • Mild memory impairment of confusion without another etiology

  • Signs of malnutrition on physical or laboratory exam

While this broad definition would appear at first to be over-inclusive, in a follow-up study of a 106 alcoholic patients who underwent autopsy, the criteria had a sensitivity of 85% and a specificity of 100% for the diagnosis of Wernicke encephalopathy. [37]

In chronic alcoholic patients who meet the Caine criteria for Wernicke encephalopathy and have features of Korsakoff amnestic syndrome, a diagnosis of Wernicke-Korsakoff Syndrome should be presumed.

These criteria have not been validated in nonalcoholic patients and a high-index of suspicion for thiamine deficiency and Wernicke-Korsakoff syndrome needs to be maintained in vulnerable populations.

The British Royal College of Physicians guidelines are similar; they suggest treating everyone who has evidence of alcohol abuse and any one of the following:

  • Acute confusion

  • Decreased consciousness

  • Ataxia

  • Ophthalmoplegia

  • Memory disturbances

  • Hypothermia hypotension

The differential diagnosis of Korsakoff psychosis includes the following:

  • Temporal lobe epilepsy

  • Temporal lobe infarction

  • Concussive head injury

  • Dementia with Lewy bodies

  • Transient global amnesia

  • Anoxic encephalopathy

  • Alzheimer disease

  • Third ventricle tumor

  • Herpes simplex virus

Differential Diagnoses