KORSAKOFF’S SYNDROME (Amne- sic-Confabulatory Syndrome)

An organic psychosis occurring primarily in chronic alcoholics and victims of severe blows on the head (head trauma) but also occasionally observed in patients with prolonged infections, metallic poisoning, and other disorders, such as pellagra and brain tumor, that involve brain damage; first described by the Russian neurologist Sergei Korsakoff (1854-1900) in 1887.Korsakoff patients are usually older men who have been drinking excessively for many years, and the syndrome generally follows an attack of delirium tremens. In both alcoholic and head injury cases the most striking symptoms are memory defect and confabulation, but alcoholic patients are also likely to suffer from polyneuritis, an inflammation of the nerves, particularly in the legs and wrists.The memory loss affects recent or present events primarily (anterograde amnesia). The patient may not recall what was just said to him, or recognize pictures and faces he saw a moment before. To fill the gaps in memory, and apparently to protect himself from anxiety produced by this defect, he cheerfully invents (that is, “confabulates”) fanciful tales or accepts the stories of others.G. N. Thompson (1959) cites the case of a fifty-year-old female alcoholic who was examined on a hot summer day in a hospital room that overlooked a courtyard filled with strong-smelling refuse thrown out by other patients. The doctor asked the woman where she was, and she answered, “You are a doctor, aren’t you? You must be the ship’s doctor.” The doctor: “When did you get aboard the ship?” The woman: “Yesterday in San Francisco. See, we are coming into New York harbor now.” When asked if she enjoyed the trip, she took a deep breath of the odorous air, and replied, “Oh, yes, isn’t this sea breeze refreshing!”In the alcoholic cases, Korsakoff’s syndrome is not due to an excess of alcohol but a severe lack of Vitamin B, since the alcoholic’s diet is usually unbalanced. This deficiency causes damage to cerebral and peripheral nerve fibers. Treatment consists of discontinuance of alcohol, liberal injections of Vitamin B, and an enriched diet. If neural damage has not been extensive, improvement occurs within six or eight weeks; but in some instances there are lasting signs of intellectual, emotional, and ethical impairment. See CONFABULATION, PELLAG- RINOUS PSYCHOSIS, BERI BERI.Illustrative Case:This forty-one-year-old male was admitted to the hospital after having been sent to a convalescent home as a chronic alcoholic, where he had spent approximately one month. On the night of his hospital admission he had apparently unscrewed the light bulb in his room, cut his wrist with it after breaking it, and subsequently wandered out into the street in his nightclothes. He had been disoriented and hallucinated and had talked about suicide. He was picked up by the police and brought to the hospital.At the time of admission he was found to be poorly nourished, dehydrated, and extremely weak. His speech was irrelevant and incoherent. His general physical condition was poor and cor pulmonale (heart-lung disease) was diagnosed secondary to emphysema. The patient was so ill that he was put on the critical list. However, he gradually began to improve and in four or five days became oriented as to person but still was disoriented as to time and place. He gave the date four years ahead of its proper time and yet named as President of the United States one who had been in office six years previously. He was unable to tell what hospital he was in and often called it the “medical and clerical hospital.” He said that he had been in the hospital for three weeks on one occasion, three months on another occasion, and overnight on still another. He would relate that the previous night he had been out for a walk with his friends. He went on to deny vehemently that he ever drank anything: “I want that understood. I never touch that stuff.” From time to time he would count the coins in his empty hand. On two or three occasions he complained that he saw snakes under his bed but said that he “saw no more than anybody else does.” He explained at great length that the lacerations of his wrists, which were actually produced by cutting them with a light bulb, were the result of his girl’s having rubbed her head against his wrist and scratched him with an ornament in her hair.For the next few days the patient talked incessantly about someone being after him. He elaborated the idea that he was in prison. From time to time he kept calling for the “housekeeper” or the “waitress.” At other times he wanted to know where “Joe” was, particularly at times when he wet or soiled himself. He gave his occupation as engineer, manager of a large automobile company, vice-president of a railroad, and carpenter, along with several other such fabrications. From time to time he became irritated about being kept in the hospital and said, “I’m going to the Supreme Court about this matter.”There were occasional evidences of further visual hallucinations when he saw “little tractors” on the floors and walls. He was capable of identifying simple objects presented to him but often fell asleep during an interview. His attention span was extremely short. When he could be gotten out of bed he showed a marked ataxia and walked with a broad base, pushing his feet along the floor. It was necessary to give him some support in his attempts to walk. Neurological examination revealed positive Babinskis and Oppenheims, (foot reflexes indicative of nerve damage). There was diminished sensory response of his legs and a poor vibratory sense.Treatment was essentially supportive, nutritional, and tranquilization. It became quite difficult to get him to drink water but he gradually and steadily improved. He grew somewhat more quiet and cheerful. He became continent and revealed a sense of humor that was a little bit too marked, often singing and cajoling the nurses into singing with him. He would answer questions without hesitance, although even several weeks after his admission there persisted very obvious fabrications. He was sent to the state hospital where he continued a marginal adjustment. (English and Finch, 1964)