A 54-year-old man is brought to the emergency department due to acute onset mental status change and double vision. On examination, he is disoriented to time and place and has a decreased attention span. Further questioning reveals memory impairment that appears to be most severe during the last several years. Neurologic examination shows horizontal nystagmus evoked on lateral gaze with bilateral weakness of the lateral rectus muscles. The patient is unable to stand without external support. Thiamine infusion is started immediately, and his condition improves significantly over the next several days. Which of the following neurologic findings is most likely to persist despite treatment?

Question

A 54-year-old man is brought to the emergency department due to acute onset mental status change and double vision.  On examination, he is disoriented to time and place and has a decreased attention span.  Further questioning reveals memory impairment that appears to be most severe during the last several years.  Neurologic examination shows horizontal nystagmus evoked on lateral gaze with bilateral weakness of the lateral rectus muscles.  The patient is unable to stand without external support.  Thiamine infusion is started immediately, and his condition improves significantly over the next several days.  Which of the following neurologic findings is most likely to persist despite treatment?

Quizplus · Accepted Answer

11ec160b_39e0_fc3e_9249_7b6de482671d_MD0001_00 The characteristic manifestations of Wernicke syndrome, a condition caused by chronic thiamine (vitamin B₁) deficiency, are as follows: Korsakoff syndrome is associated with damage to the anterior and dorsomedial thalamic nuclei. This results in memory loss and a psychological phenomenon called "confabulation." When patients with Korsakoff syndrome are unsure of a fact, they fill in the memory gap with a fabricated story that they themselves believe to be true. Korsakoff syndrome also results in an inability to form new memories (anterograde amnesia). These impairments in memory and learning are usually permanent. Thiamine should be administered immediately in all patients with suspected Wernicke encephalopathy because it can help limit irreversible neurologic damage. Educational objective: Oculomotor dysfunction, ataxia, and confusion form the triad of Wernicke syndrome. Most of these symptoms usually resolve after thiamine administration. Korsakoff syndrome is a complication of Wernicke encephalopathy, the hallmarks of which are permanent memory loss and confabulation. __________ References: Wernicke-Korsakoff syndrome. (http://www.ncbi.nlm.nih.gov/pubmed/16369858)

A 54-Year-Old Man Is Brought to the Emergency Department Due