ABSTRACT
Thiamine deficiency causes a range of subtle and nonspecific symptoms that may be easily overlooked. Nonendemic thiamine deficiency can be seen in association with alcoholism where it manifests with Wernicke–Korsakoff syndrome. The absorption of thiamine is impaired by both malnutrition and alcohol. In addition, liver disease has been associated with reduced body stores and impaired metabolism of thiamine. In alcoholics, thiamine deficiency may compound the situation by enhancing the neurotoxic effect of alcohol. The diagnosis of WernickeKorsakoff syndrome is missed in about 25% of cases. Physicians should have a low threshold to suspect this condition, particularly in alcoholics, even in the absence of the complete triad. Dietary methionine is metabolized to S-adenosylmethionine, which is necessary for the methylation of myelin sheath products. Downstream, S-adenosylmethionine is converted to homocysteine, and this may enter the remethylation or the transsulfuration pathway.
