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

  • R. R. Jacobson (a1) and W. A. Lishman (a1)


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.


Corresponding author

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


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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.
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). APA: Washington, DC.
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.
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.
Barnett, V. & Lewis, T. (1980). Outliers in Statistical Data. John Wiley: Chichester.
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.
Berlyne, N. (1972). Confabulation. British Journal of Psychiatry 120, 3139.
Butters, N. (1984). Alcoholic Korsakoff's syndrome: an update. Seminars in Neurology 4, 229247.
Butters, N. & Cermak, L. S. (1980). Alcoholic Korsakoff's Syndrome: An Information-Processing Approach to Amnesia. Academic Press: New York.
Caetano, R., Edwards, G., Oppenheim, A. N. & Taylor, C. (1978). Building a standardised alcoholism interview schedule. Drug and Alcohol Dependence 3, 185197.
Cala, L. A. & Mastaglia, F. L. (1980). Computerised axial tomography in the detection of brain damage. Medical Journal of Australia ii, 193198.
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.
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.
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16, 297334.
Critchley, M. (1983). The Parietal Lobes. Edward Arnold: London.
Cutting, J. (1978). The relationship between Korsakoff's syndrome and ‘Alcoholic dementia’. British Journal of Psychiatry, 132, 240251.
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.
Gurling, H. M. D., Murray, R. M. & Ron, M. A. (1986). Increased brain radio-density in alcoholism. Archives of General Psychiatry 43, 764767.
Hakim, A. M. & Pappius, H. M. (1981). The effect of thiamine deficiency on local cerebral glucose utilisation. Annals of Neurology 9, 334339.
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.
Harper, C. & Blumbergs, P. C. (1982). Brain weights in alcoholics. Journal of Neurology, Neurosurgery and Psychiatry 45, 838840.
Harper, C. & Kril, J. (1985). Brain atrophy in chronic alcoholic patients – a quantitative pathological study. Journal of Neurology, Neurosurgery and Psychiatry 48, 211217.
Harper, C., Krill, T. J. & Holloway, R. L. (1985). Brain shrinkage in chronic alcoholics: a pathological study. British Medical Journal 290, 501504.
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.
Harper, C., Kril, J. & Daly, J. (1987). Are we drinking our neurons away? British Medical Journal 294, 534536.
Hillbom, M. & Holm, L. (1986). Contribution of traumatic head injury to neuropsychological deficits in alcoholics. Journal of Neurology, Neurosurgery and Psychiatry 49, 13481353.
Jacobson, R. R. (1986). The contributions of sex and drinking history to the CT brain scan changes in alcoholics. Psychological Medicine 16, 547549.
Jacobson, R. R. (1987). CT Scan, Psychometric and Clinical Studies of the Wernicke-Korsakoff Syndrome. M.D. thesis. University of Cambridge.
Jacobson, R. R. & Lishman, W. A. (1987). Selective memory loss and global intellectual deficits in alcoholic Korsakoff's syndrome. Psychological Medicine 17, 649655.
Jacoby, R. J., Levy, R. & Dawson, J. M. (1980). Computed tomography in the elderly: 1. The normal population. British Journal of Psychiatry 136, 249255.
Korsakoff, S. S. (1889). Psychic disorder in conjunction with multiple neuritis. Medizinskioje Obozrenije, 31, translated in: Neurology 5, (1955) 394406.
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.
Lishman, W. A. (1981). Cerebral disorderin alcoholism. Syndromes of impairment. Brain 104, 120.
Lishman, W. A. (1987). Organic Psychiatry Second edition. Blackwell Scientific Publications: Oxford.
Lishman, W. A., Jacobson, R. R., & Acker, C. (1987). Brain damage in alcoholism: current concepts. Acta Medica Scandinavica Supplementum 717, 517.
Moscovitch, M. (1982). Multiple dissociations of function in amnesia. In Human Memory and Amnesia (ed. Cermak, L. S.), pp. 337370. Lawrence Erlbaum Associates: Hillsdale.
Philips, S. C. (1987). Can brain lesions occur in experimental animals by administration of ethanol of acetaldehyde? Acta Medica Scandinavica suppl. 717, 6772.
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.
Ron, M. A. (1983). The alcoholic brain: CT scan and psychological findings. Psychological Medicine monograph. supplement 3.
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.
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.
Skullerud, K. (1985). Variations in the size of the human brain. Acta Neurologica Scandinavia 71, Suppl. 102.
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.
Stuss, D. T. & Benson, D. F. (1986). The Frontal Lobes. Raven Press: New York.
Surridge, D. (1969). An investigation into some psychiatric aspects of multiple sclerosis. British Journal of Psychiatry 115, 749764.
Synek, V. & Reuben, J. R. (1976). The ventricular–brain ratio using planimetric measurement of EMI scans. British Journal of Radiology 49, 233237.
Thomson, A. D., Jeyasingham, M. D., Pratt, O. E. & Shaw, G. K. (1987). Nutrition and alcoholic encephalopathies. Acta Medica Scandinavica Supplementum 717, 5565.
Victor, W., Adams, R. D. & Collins, G. H. (1971). The Wernicke–Korsakoff Syndrome. Blackwell Scientific Publications: Oxford.
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.
Weinstein, E. A. & Kahn, R. L. (1955). Denial of Illness: Symbolic and Physiolgical Aspects. Charles C. Thomas: Springfield, Illinois.
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.
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.
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.
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.
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.
Zangwill, O. L. (1966). The amnesic syndrome. In Amnesia (ed. Whitty, C. W. M. and Zangwill, O. L.), pp. 7791. Butterworths: London.

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

  • R. R. Jacobson (a1) and W. A. Lishman (a1)


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