What is the most common presenting feature of Wernicke-Korsakoff syndrome?

• A. Confusion and disorientation
• B. Seizures
• C. Hearing loss
• D. Ataxia

Answer: (A)

Confusion and disorientation as the first sign reflect the global brain dysfunction caused by thiamine deficiency in Wernicke-Korsakoff syndrome. Thiamine is essential for brain energy metabolism; without it, vulnerable areas such as the mammillary bodies and thalamus suffer energy failure, leading to acute encephalopathy. While ocular abnormalities and ataxia can occur and are part of the broader spectrum, the most common presenting feature across patients is confusion, often the initial clue that prompts urgent evaluation. If not treated promptly with thiamine, progression to Korsakoff syndrome can ensue, with prominent memory deficits and confabulation. Early recognition is crucial, and treatment should start with thiamine administration before glucose if there is suspicion of deficiency. Seizures, hearing loss, and isolated ataxia are less typical as the presenting feature.