THE WERNICKE SYNDROME: With Special Reference to Manic Syndromes Associated with Hypothalamic Lesions.

THE following study is based upon five complete cases of Wernicke's syndrome. In only one case was there a history of alcoholism; two of the subjects suffered from pernicious anemia; one gave a history of hyperemesis gravidarum, and the last of gastric carcinoma. In two further cases, the one of alcoholism and the other of pernicious anxmia, no complete investigation could be carried out; it is known, however, that both these patients had Korsakow's psychosis and in both the mammillary bodies were found to be severely affected. The occurrence of the Wernicke Syndrome in all these conditions is now a recognized fact (Neubuerger, 1937; Campbell and Biggart, 1939; Sheehan, 1939; Sinclair, 1939; and others). It has also been well established that the common etiological link is a deficiency in thiamine. Alexander (1939, 1940) was able to produce lesions comparable with those of the Wernicke Syndrome in pigeons fed on thiamine-free diet rich in other foodstuffs and containing in excess the vitamins A, the remaining Bs, C, and D. Alexander's results were in accordance with those of Prickett (1934) and Zimmerman (1939/40, 1940), and have since been amplified by similar findings in foxes (Alexander, Green, Evans and Wolf, 1941; Evans, Carlson and Green, 1942) and in cats (Ferraro and Roizin, 1941). In this paper it is not proposed to describe the pathology of all the cases in detail; this would mean much repetition of findings which have been studied previously. Only one case will be given in full, as it was atypical both clinically and pathologically. The rest of the material will be utilized for comparison and also for the description of certain unusual features which have not been dealt with adequately in previous publications.