An acute cerebellar ataxia frequently develops in association with these symptoms. Most patients have underlying nutritional deficiencies. Although Wernicke's encephalopathy is a fairly common diagnosis, it is often missed or delayed, with unfortunate results. Treatment of suspected or borderline cases consists of giving parenteral thiamine 100 mg IV immediately, especially before administering fluids containing glucose. The next steps are rehydration to restore blood volume, correction of electrolyte abnormalities, and initiation of general nutritional therapy, including multivitamins.
Advanced cases require hospitalization and close supervision.
Korsakoff's syndrome often develops after a severe or repeated attack of postalcoholic delirium tremens, whether or not a typical attack of Wernicke's encephalopathy has occurred first. It also can follow subarachnoid hemorrhage, thalamic hemorrhage, thalamic ischemic stroke, and, infrequently, neoplasms affecting the paramedian posterior thalamic region. Symptoms and signs include highly characteristic memory defects. Confabulation is often a striking early feature, associated with the defect in recent memory, but is less apparent in more chronic cases. The bewildered patient substitutes imaginary or confused fabrications for those he cannot recall and may be so convincing that the physician is deceived into thinking that the patient's mental state is normal.