Vitamin Deficiencies Thiamine (Vitamin B;) Deficiency Wernicke encephalopathy is caused by thiamine deficiency and is characterized by the acute appearance of a combina- tion of psychotic symptoms and ophthalmoplegia. The acute symptoms are reversible when treated with thia- mine. However, if unrecognized and untreated, they may be followed by a prolonged and largely irreversible con- dition, called Korsakoff syndrome, that is characterized clinically by disturbances of short term memory and con- fabulation. The syndrome is particularly common in the setting of chronic alcoholism, but it may alsa be encoun- tered in individuals with thiamine deficiency resulting from gastric disorders, including carcinoma, chronic gas- tritis, or persistent vomiting. | OLOGY Wericke encephalopathy is characterized by foci of hemor- rhage and necrosis in the mamillary bodies and the walls of the third and fourth ventricles. Early iesions show dilated capillaries with prominent endothelial cells. Subsequently, the capillaries become leaky, producing hemorrhagic areas. With time, there is infiltration of macrophages and development of a cystic space with hemosiderin-laden macrophages: These chranic lesions predominate in individuals with Korsakaff syndrome. Lesions in the dorsomedial nucleus. of the thalamus seam to be the best correlate of the memory disturbance and confabulation: