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Korsakoff Syndrome MRI — RACP Adult Medicine MCQ

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ModerateNeurologyKorsakoff Syndrome MRIRACP Adult Medicine

A 50-year-old man with known alcohol-related liver disease presents with acute confusion. His wife reports he has been abstinent from alcohol for 3 months. MRI brain shows symmetrical T2 signal abnormality in the bilateral medial thalami. What is the diagnosis?

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Correct answer: E — Wernicke encephalopathy (chronic – Korsakoff syndrome)

Symmetrical T2 signal abnormality in the bilateral medial thalami on MRI is characteristic of Wernicke encephalopathy (acute) or Korsakoff syndrome (chronic). The medial thalami, mammillary bodies, periaqueductal grey matter, and tectal plate are the classic sites of involvement. In chronic alcoholism with malnutrition, thiamine deficiency can persist or worsen even after alcohol cessation if nutritional rehabilitation is inadequate. The transition from Wernicke encephalopathy to Korsakoff syndrome (irreversible amnesia with confabulation) occurs when treatment is delayed or inadequate.

Reference: eTG – 2025 – Neurology