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This patient who presents with memory loss as well as confabulation and has a previous history of alcohol use disorder, ataxia, and ophthalmoplegia most likely has Wernicke-Korsakoff syndrome. This syndrome is associated with abnormalities in the mamillary bodies. Wernicke-Korsakoff syndrome is caused by thiamine (vitamin B1) deficiency in patients with alcohol use disorder. It is a clinical diagnosis that does not require imaging studies and has 2 distinct manifestations. Wernicke encephalopathy occurs earlier and presents with altered mental status (disorientation, indifference, inattentiveness), ophthalmoplegia, and gait ataxia. Korsakoff psychosis presents later with memory loss (anterograde and retrograde), confabulation, and personality change. Wernicke encephalopathy is reversible with prompt administration of thiamine but Korsakoff psychosis is often irreversible. The classic finding on brain imaging in this disorder is hyperintensity of the mamillary bodies on MRI. Arts et al. studied the contribution of mamillary body damage to pathologies involving thiamine deficiency. They find that this finding is difficult to study in isolation given more global changes to the brain in all these pathologies. Figure A is a labeled MRI slice of the brain with labeled anatomical regions as presented in the incorrect answer choices. Incorrect Answers: Answer 1: A represents the cerebral cortex. This region of the brain can also be affected by alcohol use and results in decreased executive functioning; however, structural changes are more consistent with dementia such as in patients with Alzheimer disease. Answer 2: B represents the corpus callosum. This region of the brain is involved in connecting the cerebral hemispheres and damage to it would result in epileptic seizures or difficulties with coordination. Answer 3: C represents the thalamus. This region of the brain is involved in sensory input to the brain and damage to it can result in intractable pain. Answer 5: E represents the cerebellum. This region of the brain is also affected by alcohol and results in ataxia; however, pure intoxication would not result in chronic changes such as confabulation. Bullet Summary: Wernicke-Korsakoff syndrome is associated with imaging abnormalities in the mamillary bodies.
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