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Neurologic Sequellae of Nutritional Deficiencies 03

Topic: Imaging

Created on Wednesday, September 24 2008 by jdmiles

Last modified on Wednesday, September 24 2008.


A 66 year-old man presents with worsening confusion, nystagmus, ophthalmoparesis, and ataxia. An MRI of his brain is obtained, and is shown above.
Appropriate treatment requires IV administration of which of following?

 
        A) Vitamin C
 
        B) Vitamin B6
 
        C) Thiamine
 
        D) Penicillin
 
        E) Folate
 

 


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This question was created on September 24, 2008 by jdmiles.
This question was last modified on September 24, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) vitamin C

This answer is incorrect.


The patient's imaging and history are consistent with Wernicke encephalopathy. Vitamin C is not the definitive treatment for this disorder.  (See References)

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B) vitamin B6

This answer is incorrect.


The patient's imaging and history are consistent with Wernicke encephalopathy. Vitamin B6 is not the definitive treatment for this disorder.  (See References)

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C) thiamine

This answer is correct.


This FLAIR MRI shows hyperintensity in the medial thalamic nuclei, which is characteristic of Wernicke encephalopathy and Korsakoff dementia. The typical symptoms of Wernicke encephalopathy include ophthalmoparesis, nystagmus, ataxia, and a change in mental status characterized by confusion and apathy. Wernicke encephalopathy and Korsakoff dementia are both due to a deficiency of thiamine (vitamin B1), and both are more common in alcoholics. Treatment of Wernicke encephalopathy requires administration of thiamine. Adams and Victor recommend 50mg IV and 50mg IM immediately, followed by 50mg IM daily.  (See References)

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D) penicillin

This answer is incorrect.


The patient's imaging and history are consistent with Wernicke encephalopathy. Penicillin would not be indicated in this nutritional deficiency disorder.  (See References)

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E) folate

This answer is incorrect.


The patient's imaging and history are consistent with Wernicke encephalopathy. Folate is not the definitive treatment for this disorder.  (See References)

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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York.
2. Rowland, L.P. (Ed) (2000). Merritt's Neurology, 10th Edition. Lippincott Williams & Wilkins, Philadelphia.
3. So, Y.T., and Simon, R.P. (2004). Deficiency diseases of the nervous system. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia, pp. 1693-1708.
4. Koguchi, K., Nakatsuji, Y., Abe, K., and Sakoda, S. (2004). "Wernicke's encephalopathy after glucose infusion." Neurology, 62(3) 512. (PMID:14872047)
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imaging
Neurologic Sequellae of Nutritional Deficiencies 03
Question ID: 092408140
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 09/24/2008
Modified: 09/24/2008
Estimated Permutations: 30240

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