A 57 Year Old Man Presents With Blurry vision, Difficulty standing, and Mental confusion.

A 57-year-old man is brought to the emergency department because of blurry vision, difficulty standing, and mental confusion.
On physical examination the patient appears malnourished, he had diffuse crackles bilaterally, and on
standing his gait is wide-based and unsteady.
The patient’s friend, who accompanies him, says the patient “hasn’t been himself lately,” and is having difficulty remembering to do everyday tasks. Which neuropathologic findings are most consistent with this patient’s symptoms?

(A) Atrophy of the caudate nucleus
(B) Depigmentation within the substantia nigra pars compacta
(C) Neurofi brillary tangles and widening of ventricles
(D) No neuropathologic fi ndings
(E) Symmetric lesions in the paraventricular regions of the thalamus and hypothalamus, mammillary bodies, and periaqueductal region of the midbrain

Answer And Discussion:


The correct answer is E. This patient presents with signs and symptoms of Wernicke’s encephalopathy (confusion, ophthalmoplegia, and ataxia) and Korsakoff’s psychosis (personality change, confabulation, and memory loss).
This syndrome is secondary to thiamine deficiency and commonly seen in malnourished alcoholics. On postmortem examination, patients suffering from Wernicke-Korsakoff syndrome
commonly present with symmetric lesions in the paraventricular regions of the thalamus and hypothalamus, mammillary bodies, and periaqueductal region of the midbrain.

Answer A is incorrect. Atrophy of the caudate nucleus is found in Huntington’s disease, a disease
of autosomal dominance associated with chorea and dementia.

Answer B is incorrect. Depigmentation within the substantia nigra pars compacta is commonly
seen in Parkinson’s disease, not thiamine deficiency.

Answer C is incorrect. Neurofibrillary tangles, composed of abnormally phosphorylated tau protein, are commonly found in the frontal and temporal lobes of patients with Alzheimer’s disease.

Answer D is incorrect Thiamine deficiency is associated with neuropathologic changes observed
on postmortem examination.