Wernicke Korsakoff Syndrome : Wernicke Korsakoff Syndrome is primarily caused by the deficiency of thiamine, (Vitamin B1) usually due to chronic alcohol abuse. But Korsakoff Syndrome can have other origins other than alcohol abuse - chronic vomiting that may inhibit the absorption of Thiamine.

Neurological complications of alcohol abuse may also result from nutritional deficiency exacerbated by the excessive intake of alcohol which depletes Vitamin B1 - thiamine essential for normal nervous system. Sudden changes in blood chemistry specifically sodium, may cause central pontine myelinolysis, a condition of the brainstem in which nerves lose their myelin coating. Other complication include Liver disease and alcoholic cirrhosis.

Such conditions - if left untreated can progress to the onset of Wernicke encephalopathy - whose symptoms include marked confusion, delirium, disorientation, memory loss and drowsiness. Physical Examination may reveal abnormalities of eye movement, jerking of the eyes (nystagmus) and double vision. Even walking may seem hard to do as the patient has problems with balance and muscular co-ordination. If thiamine is not administered soon Wernicke encephalopathy may progress to stupor, coma and death.

If Thiamine is administered in time, the patient may escape from death but Korsakoff’s syndrome may still leave him/her crippled from permanent memory impairment - some may not remember events for a period of a few years before the onset of illness (retrograde amnesia) and unable to learn new information (anterograde amnesia).
Repeated episodes of Encephalopathy and/or prolonged alcohol abuse may lead to Korsakoff psychosis a form of dementia.

Alcoholic myopathy or muscular weakness due to breakdown of muscle tissue, is called as alcoholic rhabdomyolysis or alcoholic myoglobinuria. Usually men are affected by alcoholic myopathy about 4 times as often as women. Breakdown of muscle tissue (myonecrosis), can occur at any time during binge drinking or in the first days of alcohol withdrawal. Although this itself may not result in any apparent symptom in the initial stages, it can still be detected by temporary elevation in blood levels of an enzyme the MM fraction of creatine kinase - found in muscles.

Wernicke Korsakoff syndrome also known as Cerebral Beriberi, usually occurs in chronic alcoholics and affects the central nervous system (brain and spinal cord). It can be caused by a situation that aggravates a chronic thiamine deficiency, like an alcoholic binge or severe vomiting.

Delirium Tremens

Delirium Tremens or DT is a serious condition of alcohol withdrawal syndrome. DT leads to sudden and severe mental and nervous system changes.

Causes of Delirium Tremens

When a person suddenly stops drinking alcohol after a period of heavy consumption, and does not eat enough food, delirium tremens occurs. This means, a person consuming 4-5 pints (about 1880 ml ) of wine or 7-8 pints (about 3290 ml) of beer or a pint (about 470 ml ) of hard alcohol every day for several months. This could happen to people with more than a decade of drinking alcohol.

One important reason is that in long term drinkers, alcohol interferes with body's ability to regulate a neurotransmitter called GABA. In chronic alcohol abuse, the body mistakes alcohol for GABA and reacts to this by reducing its production of the neurotransmitter. As alcohol levels falls too low, it means there is not enough GABA for proper functioning. This can also occur due to infection, injury and illness in people with a history of heavy alcohol use and abuse.

Signs and symptoms of Delirium Tremens

Symptoms normally occur within 72 hours of the last drink, but they can also occur up to 10 days after the last drink. Common symptoms include:

• Body tremors
  
• Functional changes
  
• Agitation
  
• Anger and irritability
  
• Confusion and loss of focus
  
• Reduced attention span
  
• Deep sleep that lasts for a day or longer
  
• Excitement and fear
  
• Hallucination
  
• Hyperactivity
  
• Quick mood reversals
  
• Restlessness
  
• Sensitivity to light, sound and touch
  
• Sleeplessness and fatigue.
  

There could be seizures, most commonly in the first 12-48 hours after the last drink. As DT can temporarily reduce the amount of blood flow to the brain, symptoms as confusion, disorientation, stupor and loss of consciousness and hallucinations occur. There are other medical complications that can arise due to alcohol abuse. These include:

• Alcoholic liver disease
  
• Cardiomyopathy
  
• Neuropathy
  
• Blood clotting disorders
  
• Wernicke Korsakoff's syndrome, a brain disorder due to thiamine deficiency
  
• Injury from fall during seizures
  
• Irregular heartbeat which can be life threatening
  
• Delirium and injury to self/others in a state of confusion
  

The body goes through change due to withdrawal of alcohol when a person suddenly stops drinking after prolonged use. Alcohol has a slowing and sedating effect on the brain and the brain of a long term drinker is conditionally exposed to the depressant effect of alcohol. The brain starts producing naturally stimulating chemicals to compensate for the effect of alcohol. Hence, if the alcohol is withdrawn suddenly, the brain is lost. This dangerous condition of delirium tremens occurs in almost 1 out of every 20 persons. In this condition the brain is unable to read the chemistry after alcohol is stopped and therefore creates a temporary confusion leading to dangerous changes in the way the brain regulates body circulation and breathing. This creates risk of heart attack, stroke and death.

Diagnosis of DT

Blood tests can be done to assess blood magnesium and blood phosphate levels. Comprehensive metabolic panel and toxicology tests are also conducted. A stay in hospital in required for treatment. Regular checks of blood chemistry levels, such as electrolytes, body fluids level and vital signs such as temperature, pulse, breathing rate and blood pressure are monitored. Medications such as anticonvulsants, central nervous system depressants and sedatives are administered for symptoms such as seizures and irregular heartbeat. Sometimes the patient is put in a state of sedation for a week until withdrawal is complete. Benzodiazepine medications are given to treat seizures, anxiety and tremors. Only after the patient recovers from immediate symptoms is long term preventive treatment given. The doctor allows a ‘drying out' period in which no alcohol is consumed.

Aphasia

Aphasia is the inability to communicate verbally or by written words. Aphasia can be usually due to brain injury or a stroke. It can also be the result of a brain tumor, Alzheimer or Encephalitis. Aphasia can be permanent or temporary (usually known as transient aphasia). Aphasia is sometimes confused with Apraxia which is a condition that affects the muscles used in speech rather than the language function.

Aphasia can be grouped as below based on the cause and the area of the brain affected:

• Global Aphasia : Occurs due to head trauma on the language areas of the brain. Language ability affected may vary based on the location and the extent of the injury.
  
  
• Wernicke's Aphasia : Partial or total loss of the ability to understand written or spoken words though the affected person may still retain the ability to speak - but with made-up words.
  
  
• Transcortical Aphasia : Partial or total loss of the ability to express verbally or by writing words although the individual may have the ability to repeat words, phrases or even sentences
  
  
• Conduction Aphasia : Affected person loses the ability to repeat words, phrases or sentences
  
  
• Subcortical Aphasia : Partial or total loss of the ability to express verbally or by using written words due to damage to the non-language dominated areas of the brain
  
  
• Anomic Aphasia : Partial or total loss of the ability to recall the names of persons or things.
  
  
• Broca's Aphasia : Hearing comprehension is not affected
  
  

As Aphasia develops following a head trauma, tumor, disease (Alzheimer's) or infection (encephalitis), the pathways for language comprehension or production are disrupted. This occurs in the left hemisphere of the brain. MRI (magnetic resonance imaging) and CT (Computed tomography) scans can show the extent of the damage and the area affected. Coupled with standardized tests like Boston Diagnostic Aphasia Examination, the Western Aphasia Battery and Porch Index of Speech Ability, can indicate the severity of Aphasia and probable course of speech therapy.