Teaching NeuroImages:

Diagnostically deceptive but treatable A 54-year-old woman with 4 months of vomiting after gastric fundoplication presented with confusion, gener-alized weakness, anterograde amnesia, and ophthalmo-plegia. Brain MRI showed hyperintensity in the posteromedial thalami (figure, A) and periaqueductal area (figure, B). Serum thiamine was 22 nmol/L (nor-mal 70–180 nmol/L). Supplementation resulted in rapid improvement of ophthalmoplegia but slow improvement of confusion. Anterograde amnesia per-sisted despite 2 weeks of supplementation. Wernicke encephalopathy is characterized by mental status change, gait ataxia, and ophthalmo-plegia.1 Symmetrical alterations in the thalami, mamillary bodies, tectal plate, and periaqueductal areas are typically seen on MRI.2 Treatment with 1,500 mg/d thiamine is necessary for clinical improvement.1 STUDY FUNDING No targeted funding reported. DISCLOSURE The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures. REFERENCE