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Alcohol-Related Central Nervous System Disorders Associated with Vitamin B Deficiency

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Abstract

Rare but severe central nervous system complications associated with vitamin B deficiency, such as Wernicke encephalopathy, Korsakoff syndrome, and Marchiafava–Bignami disease, have been reported as a result of neurotoxicity related to alcohol use. Their pathophysiologic mechanisms remain unclear, particularly for Marchiafava–Bignami disease. These conditions remain underdiagnosed due to the non-specificity of their presenting symptoms and a lack of specific tests or diagnostic criteria. From a prognostic perspective, it is beneficial to start vitamin B complex supplementation before a definitive diagnosis. The mechanisms of thiamine deficiency–induced cell damage in Wernicke encephalopathy have been elucidated but remain unclear in Marchiafava–Bignami disease. We hypothesize that the mechanisms of Wernicke encephalopathy and Marchiafava–Bignami disease are different. Cytokine-mediated cytotoxic edema is a pathophysiological mechanism in Marchiafava–Bignami disease, in addition to vitamin B1 deficiency–related mechanisms. Although the amnesia of Korsakoff syndrome has generally been considered irreversible, recent studies have shown an improvement of cognitive function after memory rehabilitation. Alcohol-related central nervous system disorders associated with vitamin B deficiency occur in alcoholics. Rapid diagnosis and treatment of Wernicke encephalopathy and Marchiafava–Bignami disease have a profound effect on patient prognosis and prevent progression to Korsakoff syndrome. The newly proposed pathophysiological hypothesis of Marchiafava–Bignami disease may be useful for disease management in the future.

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Data Availability

The data used and analyzed during the current article are available from the corresponding author on reasonable request.

Abbreviations

WE:

Wernicke encephalopathy

KS:

Korsakoff syndrome

MBD:

Marchiafava–Bignami disease

GABA:

gamma-aminobutyric acid

ATP:

adenosine triphosphate

NADPH:

nicotinamide adenine dinucleotide phosphate

NMDA:

N-methyl-d-aspartate

GDF15:

growth differentiation factor 15

MRI:

magnetic resonance imaging

FLAIR:

fluid-attenuated inversion recovery

RCT:

randomized controlled trial

DWI:

diffusion-weighted imaging

ADC:

apparent diffusion coefficient

AQP4:

aquaporin 4

AMPA:

α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid

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Acknowledgments

The authors would like to thank Enago (www.enago.jp) for the English language review.

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  1. Department of Neurology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan

    Syuichi Tetsuka & Ritsuo Hashimoto

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  1. Syuichi Tetsuka
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Correspondence to Syuichi Tetsuka.

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Tetsuka, S., Hashimoto, R. Alcohol-Related Central Nervous System Disorders Associated with Vitamin B Deficiency. SN Compr. Clin. Med. 3, 528–537 (2021). https://doi.org/10.1007/s42399-021-00741-6

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