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Wernicke encephalopathy — SCE Neurology MCQ

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HardCognitive NeurologyWernicke encephalopathySCE Neurology

A 79-year-old man presented with confusion, ataxia and ophthalmoplegia in malnutrition. On examination, there was horizontal nystagmus and broad-based gait. Initial investigations showed: MRI showed mammillary body signal change. Where is the most likely anatomical localisation?

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Correct answer: D — mammillary bodies and periaqueductal grey

The best answer is “mammillary bodies and periaqueductal grey”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Bilateral hippocampi and entorhinal cortices”, “Caudate nuclei and anterior putamina”, “Substantia nigra and subthalamic nuclei”, “Posterior columns and dorsal-root ganglia” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/