In one quantitative study, brain volume with respect to intracranial cavity volume was determined and the mean pericerebral space was shown to rise from 8.3% of the total intracranial cavity volume in healthy controls to 11.3% in patients with ARBD and 14.7% in patients with WKS.44 Stereometric studies have suggested that this reduction in brain volume is largely accounted for by the shrinkage of white matter.45–47 Cerebellar white matter volume (especially in the vermis) is reduced48 and the corpus callo sum area is significantly thinned in individuals with alcoholism,49,50 especially those with nutritional deficiencies,51 compared with healthy controls. This finding may represent a dose effect of alcohol rather than an effect of thiamine deficiency, as white matter volume was negatively correlated with maximum daily alcohol consumption.47 The nature of the white matter loss remains unknown; however, this phenomenon probably involves changes in both myelination and axonal integrity.52
