Studies have questioned this, proposing that neither is necessarily a symptom of KS. Originally, it was thought that a lack of initiative and a flat affect were important characteristics of emotional presentation in those affected. Cortical dysfunction may have arisen from thiamine deficiency, alcohol neurotoxicity, and/or structural damage in the diencephalon. Damage to the medial dorsal nucleus or anterior nuclei of the thalamus (limbic-specific nuclei) is also associated with this disorder. KS involves neuronal loss, that is, damage to neurons gliosis, which is a result of damage to supporting cells of the central nervous system, and bleeding also occurs in mammillary bodies. These brain regions are all parts of the limbic system, which is heavily involved in emotion and memory. Thiamine is essential for the decarboxylation of pyruvate, and deficiency during this metabolic process is thought to cause damage to the medial thalamus and mammillary bodies of the posterior hypothalamus, as well as generalized cerebral atrophy. (1920) described the characteristic signs of Korsakoff syndrome with some additional features including: confabulation (false memories), fixation amnesia, paragnosia or false recognition of places, mental excitation, and euphoria.
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