Subject: Bush has Wernicke-Korsakoff syndrome from Alcoholism
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Wernicke-Korsakoff syndrome Disease
http://www.healthcentral.com/mhc/top/000771.cfm http://www.google.com / search?q=korsakoff+syndrome&sourceid=opera&num=0...
Because of his 25+ years of alcoholism, Bush has Korsakoff syndrome. No kidding. He is a CLASSIC case study.
Read this. You will fall off your chairs when you read about "confabulations" (fabrications), seizures and short term memory problems.
Particularly notice that sunlight coming through trees can bring on a seizure.
You will find this all enlightening.
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Brain disorders due to substance abuse
Alcohol abuse leads to problems with visual and spatial processing, learning and memory (such as seen with Korsakoff's syndrome), and executive functions. ( Chief Executive functions ?)
The damage is normally the most extensive in sub-cortical structures and in the frontal
lobes.
• Marijuana use leads to problems with attention, short term memory, and motor control.
• Cocaine use leads to problems that are similar to those associated with alcoholism. It is not clear if these effects from drug abuse are permanent or if they can improve with following sustained abstinence.
Duration of abuse is definitely an important factor. Some problems, such as Korsakoff's
syndrome, are definitely permanent. -- 25 years+ in Bush's case with cocaine and alcoholism..
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Korsakoff's syndrome
Definition
Korsakoff's syndrome is a memory disorder which is caused by a deficiency of vitamin B1, also called thiamine.
Description
In the United States, the most common cause of thiamine deficiency is alcoholism. Other conditions which cause thiamine deficiency occur quite rarely, but can be seen in patients undergoing dialysis (a procedure used primarily for patients suffering from kidney failure, during which the patient's blood circulates outside of the body, is mechanically cleansed, and then is circulated back into the body), pregnant women with a condition called hyperemesis gravidarum (a condition of extreme morning sickness, during which the woman vomits up nearly all fluid and food intake), and patients after surgery who are given vitamin-free fluids for a prolonged period of time. Thiamine deficiency is an important cause of disability in developing countries where the main source of food is polished rice (rice with the more nutritious outer husk removed).
An associated disorder, Wernicke's syndrome, often precedes Korsakoff's syndrome. In fact, they so often occur together that the spectrum of symptoms produced during the course of the two diseases is frequently referred to as Wernicke-Korsakoff syndrome. The main symptoms of Wernicke's syndrome include ataxia (difficulty in walking and maintaining balance), paralysis of some of the muscles responsible for movement of the eyes, and confusion. Untreated Wernicke's will lead to coma and then death.
Causes
One of the main reasons that alcoholism leads to thiamine deficiency has to do with the high-calorie nature of
alcohol. A person with a large alcohol intake often, in essence, substitutes alcohol for other, more nutritive calorie sources. Food intake drops off considerably, and multiple vitamin deficiencies develop. Furthermore, it is believed that alcohol increases the body's requirements for B vitamins, at the same time interfering with the absorption of thiamine from the intestine and impairing the body's ability to store and use thiamine. Direct neurotoxic (poisonous damage to the nerves) effects of alcohol may also play some role.
Thiamine is involved in a variety of reactions which provide energy to the neurons (nerve cells) of the brain. When thiamine is unavailable, these reactions cannot be carried out, and the important end- products of the reactions are not produced. Furthermore, certain other substances begin to accumulate, and are thought to cause damage to the vulnerable neurons. The area of the brain believed to be responsible for the symptoms of Korsakoff's syndrome is called the diencephalon, specifically the structures called the mamillary bodies and the thalamus.
Symptoms
An individual with Korsakoff's syndrome displays much difficulty with memory. The main area of memory affected is
the ability to learn new information. Usually, intelligence and memory for past events is relatively unaffected, so that an individual may remember what occurred 20 years previously, but is unable to remember what occurred 20 minutes ago. This memory defect is referred to as anterograde amnesia, and leads to a peculiar symptom called "confabulation," in which a person suffering from Korsakoff's fills in the gaps in his or her memory with fabricated or imagined information. For instance, a person may insist that a doctor to whom he or she has just been introduced is actually an old high school classmate, and may have a lengthy story to back this up. When asked, as part of a memory test, to remember the name of three objects which the examiner listed ten minutes earlier, a person with Korsakoff's may list three entirely different objects and be completely convincing in his or her certainty. In fact, one of the hallmarks of Korsakoff's is the person's complete unawareness of the memory defect, and complete lack of worry or concern when it is pointed out.
Diagnosis
Whenever someone has a possible diagnosis of alcoholism, and then has the sudden onset of memory difficulties, it
is important to seriously consider the diagnosis of Korsakoff's syndrome. While there is no specific laboratory test to diagnose Korsakoff's syndrome in a patient, a careful exam of the individual's mental state should be rather revealing. Although the patient's ability to confabulate answers may be convincing, checking the patient's retention of factual information (asking, for example, for the name of the current president of the United States), along with the patient's ability to learn new information (repeating a series of numbers, or recalling the names of three objects ten minutes after having been asked to memorize them) should point to the diagnosis. Certainly a patient known to have just begun recovery from Wernicke's syndrome, who then begins displaying memory difficulties, would be very likely to have developed Korsakoff's syndrome. A physical examination may also show signs of Wernicke's syndrome, such as peripheral neuropathy.
Treatment
Treatment of both Korsakoff's and Wernicke's syndromes involves the immediate administration of thiamine. In fact,
any individual who is hospitalized for any reason and who is suspected of being an alcoholic, should receive thiamine. The combined Wernicke- Korsakoff syndrome has actually been precipitated in alcoholic patients hospitalized for other medical illnesses, due to the administration of thiamine-free intravenous fluids (intravenous fluids are those fluids containing vital sugars and salts which are given to the patient through a needle inserted in a vein). Also, the vitamin therapy may be impaired by the feeding of carbohydrates prior to the giving of thiamine; since carbohydrates cannot be metabolized with thiamine.
Prognosis
Fifteen to twenty percent of all patients hospitalized for Wernicke's syndrome will die of the disorder. Although the
degree of ataxia nearly always improves with treatment, half of those who survive will continue to have some permanent difficulty walking. The paralysis of the eye muscles almost always resolves completely with thiamine treatment. Recovery from Wernicke's begins to occur rapidly after thiamine is given. Improvement in the symptoms of Korsakoff's syndrome, however, can take months and months of thiamine replacement. Furthermore, patients who develop Korsakoff's syndrome are almost universally memory-impaired for the rest of their lives. Even with thiamine treatment, the memory deficits tend to be irreversible, with less than 20% of patients even approaching recovery. The development of Korsakoff's syndrome often results in an individual requiring a supervised living situation. ( Like the Presidency ?)
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PETITE MAL SEIZURES -- This type of seizure is comparatively mild; it is characterized by brief impairment of consciousness, and is occasionally accompanied by loss of motor control. Epileptic Convulsions. Epilepsy is a disorder of the nervous system. Epileptics are subject to sporadic attacks of unconsciousness. A petite mal seizure may last for only a second and may not even be noticed. Seizures are particularly common among indigent persons, alcoholics, and others who have not had medical attention.
The different forms of epilepsy reveal themselves through characteristic seizure patterns. Petit mal usually involves a blank stare, rapid blinking of the eyes, incontinence, and stumbling. It lasts from 5 to 25 seconds.
B. Other causes of dementia are 2. Alcoholism
V. A seizure is defined as a sudden, disorderly discharge of cerebral neurons that results in both an alteration of brain function and of consciousness (Hughlings Jackson)
A. Etiology of seizure disorders includes
1. Cerebral lesion: tumors, congenital malformations, infections, vascular diseases
2. Biochemical disorders: drug/alcohol addiction, hypoglycemia, hypocalcemia
Symptomatic hypocalcaemia frequently occurs in patients with magnesium depletion due to chronic alcoholism (5).
3. Cerebral trauma: injury both past and present including neurosurgery
4. Epilepsy: a chronic disorder with no underlying cause; this is the strict definition of epilepsy, however it is often use interchangeably with seizure disorder
B. Seizure activity can be precipitated by a variety of factors
1. Blinking lights or by the sunlight passing through trees while driving
2. Fatigue
3. Fever
4. Infections
5. Hypoglycemia
6. Odors