From Confusional Syndrome to Korsakoff's Encephalopathy: Understanding, Detecting, Treating in a Case

Wernicke-Korsakoff encephalopathy (WKE) is a severe neuropsychiatric complication resulting from thiamine deficiency, most often secondary to chronic alcoholism. It comprises two overlapping conditions: Wernicke’s encephalopathy, characterized by acute neurological dysfunction, and Korsakoff’s syndrome, marked by persistent cognitive deficits, particularly memory impairment. This case report describes a 34-year-old male, chronic alcohol consumer, admitted with acute mental confusion, spatiotemporal disorientation, incoherent speech, and episodes of wandering. Neurological examination revealed no focal motor or sensory deficits but showed severe anterograde amnesia, confabulations, and emotional blunting. Brain MRI demonstrated cortico-subcortical atrophy, and laboratory analysis confirmed thiamine deficiency. The patient received high-dose intravenous vitamin B1 for seven days, broad vitamin supplementation, neuropsychological monitoring, and psychosocial interventions targeting alcohol withdrawal. Within 10 days, orientation and coherence of speech partially improved; however, significant memory deficits persisted at discharge. Neuropsychological evaluation revealed marked impairment in executive function and fixation memory, consistent with Korsakoff’s syndrome. This case emphasizes the importance of early recognition of delirium as a warning sign of thiamine deficiency in at-risk individuals, even in the absence of the complete Wernicke triad. Timely administration of parenteral thiamine is critical to preventing irreversible neurological damage. Furthermore, the case underlines the role of structured neuropsychological assessment in documenting the extent of cognitive impairment, guiding rehabilitation, and monitoring recovery. A multidisciplinary approach involving neurology, psychiatry, nutrition, and social services is essential to optimize functional prognosis, reduce morbidity, and prevent recurrence. This report also supports systematic screening for WKE in chronic alcoholics and other at-risk populations, as well as continued education for healthcare providers to improve early detection and management strategies.