This document discusses vitamin B1 (thiamine) deficiency. It notes that thiamine deficiency can cause dry beriberi characterized by peripheral neuropathy, wet beriberi characterized by heart failure, as well as Wernicke's encephalopathy marked by confusion, ataxia, and eye problems, and Korsakoff's psychosis characterized by memory issues. It further summarizes that Wernicke-Korsakoff syndrome is a symptom complex involving both Wernicke's disease and Korsakoff's psychosis, which can be caused by alcoholism, polished rice, or post-gastrectomy. Management involves intravenous or intramuscular thiamine supplementation.

1. Ministry of High Education
Almajmaa University
College of Medicine
Don by : Mohammed Abdullah Hazazi
3nd year medical student
Supervisor Dr. vaseem
Assistant Professor of Biochemistry

2. My Objectives

3. Overview :
• Vitamin B1 ( thiamine ) is water-soluble B-vitamin
• All B vitamins help the body convert food (carbohydrates)
into fuel (glucose), which is used to produce energy.
• B vitamins also help the body metabolize fats and protein.
• B complex vitamins are needed for healthy skin, hair, eyes,
and liver. They also help the nervous system function
properly, and are needed for good brain function.

4. • Thiamine contains a
pyrimidine ring connected
to thiazole ring By
methylene bridge
• Source: Liver, eggs, rice
and whole grain cereal .

5. CNS function
• brain function: It help in improve memory
and concentration and strengthen the nerves.
• The vitamin is used to reduce the progression
of multiple sclerosis , Alzheimer’s disease .
• ensures the development of myelin sheaths
and aids nerve functioning .

6. Vitamin B1 (thiamine) deficiency
Dry beriberi: characterized by peripheral
neuropathy (demyelination) with resultant
atrophy of the muscles of the extremities,
foot drop and wrist drop.
Wet beriberi: is marked by High output
cardiac failure with flabby four chambered
dilated heart and peripheral edema .

8. Vitamin B1 (thiamine) deficiency
Wernicke's encephalopathy: This
condition is characterized by Confusion ,
Ataxia , Ophthalmoplegia, Nystagmus.
Korsakoff's psychosis: is characterized by
Inability to remember new and old
information , amnesi , demyelination in
limbic system .

9. Thiamin
Deficiency

10. WERNICKE-KORSAKOFF SYNDROME
 it is symptom complex of Wernicke disease and the
Korsakoff's psychosis .
 Causes of deficiency
1- Chronic alcoholism (MC) + poor diet
2- Polished rice .
3-Post gastrectomy
• Pathology : Brain atrophy associated with WKS
occurs in the following regions of the brain; the
mamillary bodies, the thalamus, the periaqueductal
grey, the walls of the 3rd ventricle, the floor of the
4th ventrical, the cerebellum, and the frontal lobe.

11. WERNICKE-KORSAKOFF SYNDROME
Eye signs : nystagmus, Ophthalmoplegia ,
fixed pupils and, rarely, papilloedema .
Ataxia : broad-based gait, cerebellar signs
and vestibular paralysis .
Cognitive change : amnestic syndrome
with confabulation, restlessness, stupor and
coma .

12. investigations
magnetic resonance imaging (MRI) : The acute
lesions of the Wernicke-Korsakoff syndrome in the
mammillary bodies, and other medial thalamic
The cerebrospinal fluid (CSF) : normal or shows
modest elevation of the protein content.
Measurements of serum thiamine and red
blood cell transketolase : reduction in
transketolase.
electroencephalographic (EEG) : abnormalities,
consisting of diffuse mild to moderate slow activity.

13. management
50 to 200 mg thiamine intravenously
50 to 200 mg thiamine intramuscularly daily until
the patient resumes a normal diet.
further management of Wernicke disease involves
the use of a balanced diet and all the B vitamins

14. Summary
Vitamin B1 (thiamine) deficiency :
Dry beriberi: peripheral neuropathy (demyelination)
Wet beriberi: High output cardiac failure
Wernicke's encephalopathy: Confusion , Ataxia
Ophtalmoplegia , Nystagmus.
Korsakoff's psychosis: Inability to remember new and old
memory .
WERNICKE-KORSAKOFF SYNDROME : it is symptom
complex of Wernicke disease and the Korsakoff's psychosis .
Management : 50 to 200 mg thiamine .

15. Questions ?

16. Resources
• lippincott's biochemistry 5th edition.
• Adams and Victor's Principles of Neurology,
10th Edition page (1162 – 1167 ) .
• Kumar & Clark's Clinical Medicine, 7th
Edition (1174 – 1175 ) .

17. Thank you