Wernicke-Korsakoff Syndrome (Wet Brain)

What Is Wernicke-Korsakoff Syndrome (WKS)?

Wernicke-Korsakoff syndrome, or “wet brain,” is a neurological disorder caused by low vitamin B1 (thiamine). Chronic alcohol use is the most common cause, as it interferes with the body’s ability to absorb and use this essential nutrient.

WKS consists of two different disorders:

• Wernicke’s disease (Wernicke encephalopathy): A brain condition that causes sudden neurological symptoms like confusion, poor coordination, and vision problems.
• Korsakoff’s psychosis (Korsakoff syndrome): A type of dementia that can lead to severe memory loss or an inability to form new memories.

Wernicke’s disease is considered a medical emergency, but can often be reversed with high thiamine supplementation. If left untreated, however, it may progress into Korsakoff syndrome, which causes permanent brain damage.

Wernicke-Korsakoff Syndrome and Alcohol Use Disorder

Wernicke-Korsakoff Syndrome develops when your body doesn’t have enough vitamin B1, or “thiamine,” which lets your brain convert sugar into energy. Without enough vitamin B1, your brain doesn’t have the fuel it needs to function properly.

Alcohol makes it harder for your body to absorb and store vitamin B1, and chronic alcohol misuse can lead to a vitamin B1 deficiency. Since chronic alcohol abuse is the most common cause of the condition, it’s sometimes called “wet brain.”

Other Risk Factors for Developing Wet Brain

While chronic alcohol abuse is the leading cause of Wernicke-Korsakoff syndrome, it’s not the only one. Any condition that leads to malnutrition, poor nutrient absorption, or long-term thiamine deficiency can increase the risk of developing WKS.

Some medical conditions and lifestyle factors that may contribute to WKS include:

• Eating disorders (such as anorexia or bulimia)
• Cancer or side effects from chemotherapy
• HIV/AIDS and related metabolic complications
• Gastrointestinal issues like Crohn’s disease or ulcerative colitis
• Long-term kidney dialysis
• Extremely restrictive diets or extended fasting
• Severe or prolonged vomiting during pregnancy (hyperemesis gravidarum)
• Chronic infections that impact nutrient absorption
• Heart failure treated with long-term diuretic use

People with these conditions may not get enough thiamine from their diet or may struggle to absorb it properly, putting them at higher risk of neurological complications like WKS.

Signs and Symptoms of Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff syndrome affects areas of the brain responsible for memory, movement, vision, and sleep. As a result, people with WKS may experience changes in coordination, eye function, energy levels, and cognitive ability.

In its early stages, the symptoms of Wernicke’s disease can look a lot like alcohol withdrawal or intoxication. This makes it easy to overlook, especially in someone with a history of heavy drinking.

But if these issues persist even after alcohol consumption stops, it may be a sign of something more serious.

Wernicke’s disease requires urgent medical treatment. While there’s no cure, early intervention with thiamine can stop the condition from getting worse and, in some cases, reverse symptoms before they progress into Korsakoff’s psychosis.

Early Warning Signs of WKS

In the early stages of Wernicke’s disease, the first part of WKS, symptoms often appear suddenly and may be mistaken for intoxication or withdrawal.

However, these signs are actually the brain’s response to severe thiamine deficiency and should be taken seriously.

A person in the early stages of WKS may show:

• Balance problems
• Unsteady walking gait
• Confusion
• Double vision
• Loss of muscle coordination (ataxia)
• Shaking or twitching
• Drowsiness
• Rapid heartbeat
• Lowered blood pressure
• Abnormal eye movement

Around 50% of people with Wernicke’s disease end up also developing Korsakoff’s psychosis, but the odds increase to 80% for people with alcohol abuse disorder.

Symptoms of Wernicke-Korsakoff Syndrome

If Wernicke’s disease goes untreated, it can lead to Korsakoff’s psychosis—a chronic and often irreversible condition caused by lasting damage to the brain.

Unlike the earlier, more acute stage of WKS, Korsakoff’s primarily affects memory, behavior, and cognitive function.

Common symptoms of Korsakoff’s psychosis include:

• Severe memory loss, especially for recent events
• Confabulation, or unintentionally making up false memories
• Difficulty forming new memories (i.e., anterograde amnesia)
• Repetitive behaviors or speech
• Trouble planning, organizing, or solving problems
• Poor decision-making and lack of insight
• Apathy or low motivation
• Mood swings, irritability, or unexplained anger
• Hallucinations in some advanced cases

These symptoms may appear gradually and can persist even if the person stops drinking. In many cases, the damage caused by Korsakoff’s psychosis is permanent, though treatment may help stabilize or slightly improve function over time.

Diagnosis and Treatment for Wernicke-Korsakoff Syndrome

To diagnose Wernicke-Korsakoff syndrome, a healthcare provider will typically check for signs of thiamine (vitamin B1) deficiency and rule out other conditions with similar symptoms, such as concussions, dementia, or certain infections like herpes simplex virus.

Unfortunately, WKS is often missed—some estimates suggest it goes undiagnosed in up to 80% of cases.

It’s common for people to hide their alcohol use due to shame or fear of judgment. But when it comes to time-sensitive conditions like Wernicke-Korsakoff syndrome, honesty is critical.

Being upfront about alcohol use can help providers identify the problem sooner and start treatment before permanent brain damage occurs.

How Is Wernicke-Korsakoff Syndrome Diagnosed?

Diagnosing Wernicke-Korsakoff syndrome can be challenging because its symptoms often overlap with other neurological or substance-related conditions.

There’s no single test for WKS, so healthcare providers rely on a combination of clinical tools to make an accurate diagnosis.

A healthcare provider may use:

• Physical exams
• Bloodwork, like a complete blood count and toxicology screening
• Personal medical history and family history
• Imaging tests, like CT scans or MRIs

Treating Wernicke-Korsakoff Syndrome

Treatment for Wernicke-Korsakoff syndrome focuses on correcting the underlying thiamine deficiency and managing any related complications. In most cases, high doses of vitamin B1 are given through tablets, injections, or IVs.

A full treatment plan may also include:

• Nutritional support to address poor nutrition habits
• Medications to help manage specific neurological or psychological symptoms
• Inpatient or outpatient treatment for alcohol use disorder

Recovery and Long-Term Outlook

The outlook depends heavily on how advanced the condition is when treatment begins.

If Wernicke’s disease is caught early, symptoms such as confusion, vision changes, and loss of coordination may improve within 5 to 12 days. In some cases, these symptoms can be reversed entirely.

However, once Korsakoff’s psychosis develops, the damage is often permanent. 

Only about 1 in 5 people recover fully from the memory-related symptoms. The rest may experience long-term cognitive impairments, with approximately 25% requiring institutional care. The estimated mortality rate is between 10% and 15%.

Avoiding alcohol is critical at every stage. People with alcohol-induced Wernicke-Korsakoff syndrome may need detox or structured rehab to manage withdrawal and support long-term sobriety.

Get Help for Alcohol Addiction

If you or a loved one deal with alcohol abuse, don’t wait until you lose your memories. Now is the time to get treatment and protect your neurological well-being.

Ask your doctor about addiction treatment clinics or specialists in your area. You can also find treatment options through SAMHSA’s online treatment locator or by visiting our treatment help page.

Self-help groups like Alcoholics Anonymous (AA) or SMART Recovery can offer a supportive community. By reaching out, you’ve already made the first steps of your recovery journey.

Reviewed by

• Fact-Checked
• Editor

Kent S. Hoffman, D.O.

Co-Founder & Chief Medical Officer

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.