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Dieser Fallbericht beschreibt einen 59-j\u00e4hrigen Patienten, der sich aufgrund seiner klinischen Symptomatik zun\u00e4chst in internistischer Behandlung befand, da kardiovaskul\u00e4re und metabolische Komorbidit\u00e4ten eine komplexe Diagnostik notwendig machten. Die prim\u00e4re Verdachtsdiagnose eines, in der klinischen Symptomatik oft \u00e4hnlich dem KS imponierenden, osmotischen Demyelinisierungssyndroms (fr\u00fcher: pontine Myelinolyse) konnte erst durch den MRT-Nachweis einer Atrophie der Corpora mamillaria ausgeschlossen und schlie\u00dflich die Diagnose eines KS gesichert werden. Unter hochdosierter Thiamin-Supplementation, neurorehabilitativen Ma\u00dfnahmen und mit Unterst\u00fctzung durch ein stabiles soziales Umfeld zeigte sich im Verlauf eine Verbesserung der kognitiven Leistungsf\u00e4higkeit. 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