Neurology: Case of the Month

Test Yourself — Patient 54

Wernicke's Encephalopathy (presenting with optic neuropathy)

  1. Approximately what percentage of patients with Wernicke's encephalopathy have all three findings of "Wernicke's triad" (altered mental status, nystagmus and ataxia) on initial presentation?
    • [ A ] Under 5%
    • [ B ] 20%
    • [ C ] 50-60%
    • [ D ] 75-80%
    • [ E ] Over 90%
  2. Thiamine plays a central role in the metabolism of which of the following energy sources:
    • [ A ] Amino acids
    • [ B ] Carbohydrates
    • [ D ] Alcohol
  3. Which midline brain structure does NOT typically show significant damage on autopsy (and often on MRI) in patients with Wernicke's encephalopathy?
    • [ A ] Posterior pituitary gland
    • [ B ] Midbrain
    • [ C ] Mamillary bodies
    • [ D ] Thalamus and hypothalamus
    • [ E ] Superior cerebellar vermis
  4. Approximately what percentage of patients with Wernicke's encephalopathy present with visual impairment as one of their symptoms?
    • [ A ] Less than 0.1%
    • [ B ] 0.1 to 1%
    • [ C ] 1 to 5%
    • [ D ] 5 to 10%
  5. Visual impairment associated with Wernicke's encephalopathy typically begins to respond to thiamine treatment within what time interval?
    • [ A ] Hours
    • [ B ] Days
    • [ C ] Weeks
    • [ D ] Visual impairment in Wernicke's encephalopathy does not respond to thiamine

 

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