Amnesic syndrome

The most common type of amnesic syndrome is Wernicke-Korsakov syndrome, which is fundamentally due to thiamine depletion, almost always in the context of alcohol misuse. 'Wernicke' refers to the acute encephalopathic presentation (confusion and neurological signs, usually in a known alcoholic - parenteral thiamine treatment is mandatory), and 'Korsakov' to the chronic memory defect state. The brain structures involved, necessary for the laying down of new memories, have been described as the circuit of Papez (Sperling, 2001): the hippocampus and nearby areas in the mesial temporal lobe, fornix, mammillary bodies, and thalamus.

Causes

The causes of this syndrome are as follows:

• thiamine deficiency, usually secondary to alcoholism, and occasionally secondary to other causes of nutritional deficiency

• carbon monoxide poisoning

• vascular lesions

• the aftermath of hypoxia (such as may follow anaesthetic accidents, or attempted suicide by hanging) or hypoglycaemia

• encephalitis. Clinical features

The memory of recent events is grossly impaired, but immediate recall and long-term memory are both preserved, as are other intellectual functions. Many patients confabulate; that is, they conceal their memory defect by elaborate falsification.

Treatment

Thiamine may be helpful if thiamine deficiency is present. Memory aids may enable some patients to function adequately, but many need constant supervision. Alcohol should be avoided, but therapy for this is inherently difficult due to the memory problems.

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