skip to main content

Wernicke-Korsakoff neuropathology — MRCPsych Paper A MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeuropathologyWernicke-Korsakoff neuropathologyMRCPsych Paper A

A 51-year-old man with alcohol dependence develops acute confusion, a broad-based ataxic gait and ophthalmoplegia. Treatment is delayed, and he subsequently has persistent severe anterograde amnesia with confabulation. Which neuropathological pattern is most likely?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Atrophy of the mammillary bodies and medial thalamic nuclei

The acute combination of confusion, ataxia and ophthalmoplegia indicates Wernicke encephalopathy due to thiamine deficiency. Persistent anterograde amnesia and confabulation indicate progression to Korsakoff syndrome. The characteristic pathology involves the diencephalic memory circuit, particularly atrophy or injury of the mammillary bodies and medial thalamic nuclei. Neocortical amyloid plaques and tangles indicate Alzheimer disease. Anterior temporal TDP-43 pathology is associated with semantic-variant frontotemporal dementia. Caudate atrophy with mutant huntingtin inclusions indicates Huntington disease, while nigral neuronal loss and alpha-synuclein Lewy bodies indicate Parkinson disease or dementia with Lewy bodies. None explains the characteristic acute Wernicke syndrome followed by chronic amnesia.

Reference: Sullivan EV, Pfefferbaum A. Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol and Alcoholism. 2009;44(2):155-165. https://pubmed.ncbi.nlm.nih.gov/19066199/