Question 2585
{"accessible":true,"alternatives":[{"id":12685,"text":"Wernicke encephalopathy"},{"id":12686,"text":"Acute hepatic encephalopathy"},{"id":12687,"text":"Basilar artery occlusion"},{"id":12688,"text":"Internal cerebral vein thrombosis"},{"id":12689,"text":"Neuromyelitis optica spectrum disorder"}],"archived":false,"correctAlternativeId":12685,"explanation":"\u003cp\u003eBilateral symmetric FLAIR hyperintensity involving the medial thalami, mammillary bodies, and periaqueductal grey in a patient with acute altered mental status is characteristic of Wernicke encephalopathy. This patient was immediately treated with intravenous thiamine repletion and a blood thiamine (vitamin B1) level sent at the same time later confirmed deficiency of this nutrient.\u003c/p\u003e\u003cp\u003eAcute hepatic encephalopathy can involve the thalami but should also involve cerebral cortex (such as the insulae and cingulate gyri) and does not typically involve the mammillary bodies and periaqueductal region.\u003c/p\u003e\u003cp\u003eTop of the basilar artery occlusion, internal cerebral vein thrombosis, and neuromyelitis optica spectrum disorder can cause infarcts, edema, or demyelination, respectively, in the midbrain and thalami, but the pattern of involvement in these images, without more extensive involvement elsewhere, is more specific for Wernicke encephalopathy.\u003c/p\u003e","id":2585,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/549/MCQ_wernicke_big_gallery.jpeg","imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/2586","nextQuestionPath":"/articles/wernicke-encephalopathy/questions/2380","relatedArticles":[{"id":4452,"title":"Deep cerebral vein thrombosis","link":"/articles/deep-cerebral-vein-thrombosis?lang=us"},{"id":21635,"title":"Hepatic encephalopathy","link":"/articles/hepatic-encephalopathy?lang=us"},{"id":971,"title":"Acute basilar artery occlusion","link":"/articles/acute-basilar-artery-occlusion?lang=us"},{"id":1218,"title":"Neuromyelitis optica spectrum disorder","link":"/articles/neuromyelitis-optica-spectrum-disorder?lang=us"}],"alsoUsedIn":[{"id":1397,"kind":"RestrictedPage","title":"Page 1397 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/1397"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders/pages/2238"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults Peer Review - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders-peer-review/pages/2238"}],"stem":"\u003cp\u003eA 70-year-old woman presents with 3 days of confusion and is assessed with the MRI shown. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2585"}],"attemptsPercentages":[{"alternativeId":"12686","percentage":2},{"alternativeId":"12689","percentage":4},{"alternativeId":"12685","percentage":87},{"alternativeId":"12687","percentage":3},{"alternativeId":"12688","percentage":4}],"promptToLogin":false,"questionManager":false,"articleId":"wernicke-encephalopathy"}