Question

A chronic alcoholic is brought to the emergency department with confusion, ataxia, and painful eye movements. The 6th cranial nerve is also involved. What is the likely diagnosis?

• A. Wernicke's encephalopathy
• B. Korsakoff psychosis
• C. Delirium tremens
• D. De Clerambault syndrome

Answer 1

The Correct Option is A

In the case presented, the symptoms of confusion, ataxia, and painful eye movements in a chronic alcoholic, along with the involvement of the 6th cranial nerve, point towards a diagnosis of Wernicke's encephalopathy.

Wernicke's encephalopathy is a neurological disorder caused by a deficiency of thiamine (vitamin B1), which is common in chronic alcoholics due to poor nutrition and absorption issues. The classic triad of symptoms for this condition includes:

• Confusion: Mental status changes and disorientation.
• Ataxia: Unsteady gait and lack of coordination.
• Ophthalmoplegia: Painful eye movements or paralysis of eye muscles, often involving the 6th cranial nerve which controls lateral eye movements.

The correct diagnosis from the options provided is Wernicke's encephalopathy. Immediate administration of thiamine is crucial, as it can prevent progression to the more severe Korsakoff psychosis.