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Lacunar stroke — SCE Neurology MCQ

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HardStrokeLacunar strokeSCE Neurology

A malnourished patient with alcohol dependence develops confusion, bilateral abduction weakness, gaze-evoked nystagmus and a broad-based gait. Blood glucose is low-normal. What treatment should not await imaging?

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

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Correct answer: C — Give parenteral thiamine before carbohydrate and continue an appropriate treatment course

The best answer is “Give parenteral thiamine before carbohydrate and continue an appropriate treatment course”. Confusion, ocular motor dysfunction and ataxia in a malnourished patient indicate suspected Wernicke encephalopathy; parenteral thiamine is urgent and should precede carbohydrate. “Give oral thiamine only after the patient resumes a full diet” is plausible in a different neurological context, but the decisive findings here argue against it. “Use intravenous glucose alone because ocular signs imply hypoglycaemia” is plausible in a different neurological context, but the decisive findings here argue against it. “Start corticosteroids for presumed inflammatory rhombencephalitis” is plausible in a different neurological context, but the decisive findings here argue against it. “Treat with levodopa for a nutritional basal-ganglia syndrome” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: NICE CG100 alcohol-related physical complications recommendations: https://www.nice.org.uk/guidance/cg100/chapter/recommendations