The syndrome may be partial and a high index of suspicion is essential for diagnosis, especially in debilitated patients with unexplained mental confusion. Administration of thiamine causes a rapid reversal of ophthalmoplegia within hours. Recovery from nystagmus and confusion is slower.
Amnesia shows an incomplete response to treatment.
The acute lesions of WKS show an incomplete loss of neurons and loosening or vacuolization of the neuropil, and may be associated with punctate hemorrhages. Each successive bout of WKS causes additional loss of neural tissue. In burned out cases, the involved structures shrink and turn a brownish color due to lipofuscin derived from the breakdown of neurons and hemosiderin derived from the hemorrhages. The lesions have a characteristic anatomical distribution. The mammillary bodies are involved in all cases.