Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-27T04:35:14.230Z Has data issue: false hasContentIssue false

Cortical and diencephalic lesions in Korsakoff's syndrome: a clinical and scan study

Published online by Cambridge University Press:  09 July 2009

R. R. Jacobson*
Affiliation:
Institute of Psychiatry, London
W. A. Lishman
Affiliation:
Institute of Psychiatry, London
*
1Address for correspondence: Dr R. R. Jacobson, St George's Hospital Medical School, Department of Psychiatry, Jenner Wing, Cranmer Terrace, Tooting, London SW17 0RE.

Synopsis

Twenty-five male alcoholic Korsakoff patients were compared with age and sex-matched non-Korsakoff chronic alcoholics and healthy volunteers on clinical and CT brain scan parameters. The scans were assessed by planimetry, visual grading procedures and computerized analysis. Reliable measures of third ventricular size were developed.

The Korsakoff patients had wider third ventricles, larger lateral ventricles and wider interhemispheric fissures than the comparison groups; but sulcal and Sylvian fissure widths were equivalent in Korsakoff and non-Korsakoff alcoholics.

The results suggest that, in addition to their well-established diencephalic lesions, many Korsakoff patients have sustained widespread cerebral damage. Shrinkage in the frontal brain regions appears to be especially pronounced. The implications for a dual aetiology of alcoholic Korsakoff's syndrome involving thiamine deficiency and features associated with alcoholism, probably direct alcohol neurotoxicity, are discussed.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Acker, W., Aps, E. J., Majumdar, S. K., Shaw, G. K. & Thomson, A. D. (1982). The relationship between brain and liver damage in chronic alcoholic patients. Journal of Neurology, Neurosurgery and Psychiatry 45, 984987.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). APA: Washington, DC.Google Scholar
Arendt, T., Bigl, V., Arendt, A. & Tennstedt, A. (1983). Loss of neurons in the nucleus basalis of Meynert in Alzheimer's disease, paralysis agitans and Korsakoff's disease. Acta Neuropathologica 61, 101108.CrossRefGoogle ScholarPubMed
Baldy, R. E., Brindley, G. S., Ewusi-Mensah, I., Jacobson, R. R., Reveley, M. A., Turner, S. W. & Lishman, W. A. (1986). A fully automated computer-assisted method of CT brain scan analysis for the measurement of cerebrospinal fluid spaces and brain absorption density. Neuroradiology 28, 109117.CrossRefGoogle ScholarPubMed
Barnett, V. & Lewis, T. (1980). Outliers in Statistical Data. John Wiley: Chichester.Google Scholar
Bergman, H., Borg, S., Hindmarsh, T., Idestrom, C. M. & Mutzell, S. (1980). Computed tomography of the brain, clinical examination and neuropsychological assessment of a random sample of men from the general population. Acta Psychiatrica Scandinavica 62, Suppl. 286, 4756.CrossRefGoogle Scholar
Berlyne, N. (1972). Confabulation. British Journal of Psychiatry 120, 3139.CrossRefGoogle ScholarPubMed
Butters, N. (1984). Alcoholic Korsakoff's syndrome: an update. Seminars in Neurology 4, 229247.CrossRefGoogle Scholar
Butters, N. & Cermak, L. S. (1980). Alcoholic Korsakoff's Syndrome: An Information-Processing Approach to Amnesia. Academic Press: New York.Google Scholar
Caetano, R., Edwards, G., Oppenheim, A. N. & Taylor, C. (1978). Building a standardised alcoholism interview schedule. Drug and Alcohol Dependence 3, 185197.CrossRefGoogle ScholarPubMed
Cala, L. A. & Mastaglia, F. L. (1980). Computerised axial tomography in the detection of brain damage. Medical Journal of Australia ii, 193198.CrossRefGoogle Scholar
Carlen, P. L., Wilkinson, D. A., Wortzman, G., Holgate, R., Cordingley, J., Lee, M. A., Huszar, L., Moddel, G., Singh, R., Kiraly, L. & Rankin, J. G. (1981). Cerebral atrophy and functional deficits in alcoholics without clinically apparent liver disease. Neurology 31, 377385.CrossRefGoogle ScholarPubMed
Chick, J., Kreitman, N. & Plant, M. (1981). Mean cell volume and gamma-glutamyl trans-peptidase as markers of drinking in working men. Lancet i, 12491251.CrossRefGoogle Scholar
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16, 297334.CrossRefGoogle Scholar
Critchley, M. (1983). The Parietal Lobes. Edward Arnold: London.Google Scholar
Cutting, J. (1978). The relationship between Korsakoff's syndrome and ‘Alcoholic dementia’. British Journal of Psychiatry, 132, 240251.CrossRefGoogle Scholar
Gill, J. S., Zezulka, A. V., Shipely, M. J., Gill, S. K. & Beevers, D. G. (1986). Stroke and alcohol consumption. New England Journal of Medicine 315, 10411046.CrossRefGoogle ScholarPubMed
Gurling, H. M. D., Murray, R. M. & Ron, M. A. (1986). Increased brain radio-density in alcoholism. Archives of General Psychiatry 43, 764767.CrossRefGoogle Scholar
Hakim, A. M. & Pappius, H. M. (1981). The effect of thiamine deficiency on local cerebral glucose utilisation. Annals of Neurology 9, 334339.CrossRefGoogle Scholar
Harper, C. (1983). The incidence of Wernicke's encephalopathy in Australia – a neuropathological study of 131 cases. Journal of Neurology, Neurosurgery and Psychiatry 46, 593597.CrossRefGoogle Scholar
Harper, C. & Blumbergs, P. C. (1982). Brain weights in alcoholics. Journal of Neurology, Neurosurgery and Psychiatry 45, 838840.CrossRefGoogle ScholarPubMed
Harper, C. & Kril, J. (1985). Brain atrophy in chronic alcoholic patients – a quantitative pathological study. Journal of Neurology, Neurosurgery and Psychiatry 48, 211217.CrossRefGoogle ScholarPubMed
Harper, C., Krill, T. J. & Holloway, R. L. (1985). Brain shrinkage in chronic alcoholics: a pathological study. British Medical Journal 290, 501504.CrossRefGoogle ScholarPubMed
Harper, C. G., Giles, M. & Finlay-Jones, R. (1986). Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. Journal of Neurology, Neurosurgery and Psychiatry 49, 341345.CrossRefGoogle ScholarPubMed
Harper, C., Kril, J. & Daly, J. (1987). Are we drinking our neurons away? British Medical Journal 294, 534536.CrossRefGoogle ScholarPubMed
Hillbom, M. & Holm, L. (1986). Contribution of traumatic head injury to neuropsychological deficits in alcoholics. Journal of Neurology, Neurosurgery and Psychiatry 49, 13481353.CrossRefGoogle ScholarPubMed
Jacobson, R. R. (1986). The contributions of sex and drinking history to the CT brain scan changes in alcoholics. Psychological Medicine 16, 547549.CrossRefGoogle Scholar
Jacobson, R. R. (1987). CT Scan, Psychometric and Clinical Studies of the Wernicke-Korsakoff Syndrome. M.D. thesis. University of Cambridge.Google Scholar
Jacobson, R. R. & Lishman, W. A. (1987). Selective memory loss and global intellectual deficits in alcoholic Korsakoff's syndrome. Psychological Medicine 17, 649655.CrossRefGoogle ScholarPubMed
Jacoby, R. J., Levy, R. & Dawson, J. M. (1980). Computed tomography in the elderly: 1. The normal population. British Journal of Psychiatry 136, 249255.CrossRefGoogle Scholar
Korsakoff, S. S. (1889). Psychic disorder in conjunction with multiple neuritis. Medizinskioje Obozrenije, 31, translated in: Neurology 5, (1955) 394406.Google Scholar
Lesch, P., Schmidt, E. & Schmidy, F. W. (1979). Effects of chronic alcohol abuse on the structural lipids in the human brain. Zeitschrift für Klinische Chemie und Klinische Biochemie, 10, 410415.Google Scholar
Lishman, W. A. (1981). Cerebral disorderin alcoholism. Syndromes of impairment. Brain 104, 120.CrossRefGoogle Scholar
Lishman, W. A. (1987). Organic Psychiatry Second edition. Blackwell Scientific Publications: Oxford.Google Scholar
Lishman, W. A., Jacobson, R. R., & Acker, C. (1987). Brain damage in alcoholism: current concepts. Acta Medica Scandinavica Supplementum 717, 517.CrossRefGoogle ScholarPubMed
Moscovitch, M. (1982). Multiple dissociations of function in amnesia. In Human Memory and Amnesia (ed. Cermak, L. S.), pp. 337370. Lawrence Erlbaum Associates: Hillsdale.Google Scholar
Philips, S. C. (1987). Can brain lesions occur in experimental animals by administration of ethanol of acetaldehyde? Acta Medica Scandinavica suppl. 717, 6772.CrossRefGoogle Scholar
Philips, S. C. & Cragg, B. G. (1984). Alcohol withdrawal causes a loss of cerebellar Purkinje cells in mice. Journal of Studies on Alcohol 45, 475480.CrossRefGoogle Scholar
Ron, M. A. (1983). The alcoholic brain: CT scan and psychological findings. Psychological Medicine monograph. supplement 3.CrossRefGoogle Scholar
Ron, M. A., Acker, W., Shaw, G. K. & Lishman, W. A. (1982). Computerised tomography of the brain in chronic alcoholics: a survey and follow-up study. Brain 105, 497514.CrossRefGoogle ScholarPubMed
Schaeffer, K. W., Parsons, O. A. & Yohman, J. R. (1984). Neuropsychological differences between male familial and nonfamilial alcoholics and nonalcoholics. Alcoholism: Clinical and Experimental Research 8, 347351.CrossRefGoogle ScholarPubMed
Skullerud, K. (1985). Variations in the size of the human brain. Acta Neurologica Scandinavia 71, Suppl. 102.Google Scholar
Squire, L. R. (1982). Comparisons between forms of amnesia: some deficits are unique to Korsakoff's syndrome. Journal of Experimental Psychology. Learning, Memory and Cognition 8, 560571.CrossRefGoogle ScholarPubMed
Stuss, D. T. & Benson, D. F. (1986). The Frontal Lobes. Raven Press: New York.Google Scholar
Surridge, D. (1969). An investigation into some psychiatric aspects of multiple sclerosis. British Journal of Psychiatry 115, 749764.CrossRefGoogle ScholarPubMed
Synek, V. & Reuben, J. R. (1976). The ventricular–brain ratio using planimetric measurement of EMI scans. British Journal of Radiology 49, 233237.CrossRefGoogle ScholarPubMed
Thomson, A. D., Jeyasingham, M. D., Pratt, O. E. & Shaw, G. K. (1987). Nutrition and alcoholic encephalopathies. Acta Medica Scandinavica Supplementum 717, 5565.CrossRefGoogle Scholar
Victor, W., Adams, R. D. & Collins, G. H. (1971). The Wernicke–Korsakoff Syndrome. Blackwell Scientific Publications: Oxford.Google ScholarPubMed
Walker, D. W., Barnes, D. E., Zornetzer, S. F., Hunter, B. E. & Kubaris, P. (1980). Neuronal loss in hippocampus induced by prolonged ethanol consumption in rats. Science 209, 711713.CrossRefGoogle ScholarPubMed
Weinstein, E. A. & Kahn, R. L. (1955). Denial of Illness: Symbolic and Physiolgical Aspects. Charles C. Thomas: Springfield, Illinois.CrossRefGoogle Scholar
West, J. R., Lind, M. D., Demuth, R. M., Parker, E. S., Alkana, R. L., Cassell, M. & Black, A. C. (1982). Lesion-induced sprouting in the rat dentate gyrus is inhibited by repeated ethanol administration. Science 218, 808810.CrossRefGoogle ScholarPubMed
Wilkinson, D. A. (1987). CT scan and neuropsychological assessments of alcoholism. In Neuropsychology of Alcoholism: Implications for Diagnosis and Treatment (ed. Parsons, O. A., Butters, N. and Nathan, P.), pp. 76102. Guilford Press: New York.Google Scholar
Wilkinson, D. A. & Carlen, P. L. (1980). Neuropsychological and neurological assessment of chronic alcoholism: discrimination between groups of alcoholic subjects. Journal of Studies on Alcohol 41, 129139.CrossRefGoogle Scholar
Witt, E. D. & Goldmann-Rakic, P. S. (1983). Intermittent thiamine deficiency in the rhesus monkey. I. Progression of neurological signs and neuroanatomical lesions. Annals of Neurology 13, 376395.CrossRefGoogle ScholarPubMed
Wyke, M. & Warrington, E. (1960). An experimental analysis of confabulation in a case of Korsakoff's syndrome using a tachistoscopic method. Journal of Neurology, Neurosurgery and Psychiatry 23, 327333.CrossRefGoogle Scholar
Zangwill, O. L. (1966). The amnesic syndrome. In Amnesia (ed. Whitty, C. W. M. and Zangwill, O. L.), pp. 7791. Butterworths: London.Google Scholar