All are features of Wernicke encephalopathy except: (E. REPEAT 2010)

Ref: Harrison's Principles of Internal Medicine, 18th edition. Page 2260Explanation:WERNICKE'S ENCEPHAIOPATHYCaused by thiamine (B1) deficiency.Thiamine is the cofactor for enzymes:o Transketolase.o a-ketoglutarate dehydrogenaseo Pyruvate dehydrogenase.Thiamine deficiency:o Decreased brain glucose utilizationo Accun.ulation of glutamateo Cell mitochondrial damage.Occurs in:o Alcoholics.o Malnourishment due to hyperemesis, starvation, dialysis. AIDS and cancer.Clinical Features:o Global confusiono Ataxia of gait. Imbalanceo Ophthalmoplegia causing diplopia. Nystagmuso Memory loss.o Polyneuropathy.o If untreated-stupor, coma and death.Pathophy siology - Affected areaso Dorsomedial thalamus.o Mamillary bodieso Periaquiductal grey mattero Abducens nucleio Trochlear nuclei.MR1 brain-Mamillary body enhancement.Improves with prompt intravenous/ intramuscular thiamine 100 mg administration.Untreated can lead to irreversible amnestic syndrome- Korsakoff's syndrome.Glucose may precipitate or worsen the defect.