Neuroimaging: Wernicke encephalopathy: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: Wernicke encephalopathy

Sample item

A malnourished alcoholic with confusion, ataxia and ophthalmoplegia has MRI showing symmetric T2 hyperintensity in the mammillary bodies and medial thalami. What is the diagnosis and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Wernicke encephalopathy, intravenous thiamine

Thiamine deficiency affects the mammillary bodies, periaqueductal grey, medial thalami and tectal plate, with high T2 signal and enhancement. Urgent parenteral thiamine must be given before glucose. Delay may cause irreversible Korsakoff syndrome.

Option by option

  • A. Wilson disease, penicillamine

    Wilson disease causes putamen and thalamic changes, including the face of the giant panda.

  • B. Hepatic encephalopathy, lactulose

    Hepatic encephalopathy shows basal ganglia T1 hyperintensity.

  • C. Hypoglycaemia, dextrose only

    Dextrose alone can precipitate or worsen Wernicke encephalopathy.

  • D. Wernicke encephalopathy, intravenous thiamine (correct)

    Correct. Mammillary body and medial thalamic changes indicate Wernicke encephalopathy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Wernicke encephalopathy, intravenous thiamine. Thiamine deficiency affects the mammillary bodies, periaqueductal grey, medial thalami and tectal plate, with high T2 signal and enhancement.

Why is "Wilson disease, penicillamine" not the answer?

Wilson disease causes putamen and thalamic changes, including the face of the giant panda.

Why is "Hepatic encephalopathy, lactulose" not the answer?

Hepatic encephalopathy shows basal ganglia T1 hyperintensity.

Why is "Hypoglycaemia, dextrose only" not the answer?

Dextrose alone can precipitate or worsen Wernicke encephalopathy.

What concept does this question test?

It tests Neuroimaging: Wernicke encephalopathy in Radiology. Urgent parenteral thiamine must be given before glucose. Delay may cause irreversible Korsakoff syndrome.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: Wernicke encephalopathy?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.