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Wednesday, March 16, 2005

AIPG 2005 Psychiatry Wernicke encephalopathy

A 45-year-male with a history of alcohol dependence presents with confusion nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
1. Korsakoff's psychosis.
2. Wernicke encephalopathy.
3. De Clerambault syndrome.
4. Delirium tremens.
2. Wernicke encephalopathy.
A Short Textbook of Psychiatry by Ahuja 4 ed Page 36
Repeat (from the same question paper !!!)
Wernicke's disease is a common and preventable disorder due to a deficiency of thiamine. Alcoholics account for most cases, but patients with malnutrition due to hyperemesis, starvation, renal dialysis, cancer, or AIDS are also at risk. The characteristic clinical triad is that of ophthalmoplegia, ataxia, and global confusion. However, only one-third of patients with acute Wernicke's disease present with the classic clinical triad. Most patients are profoundly disoriented, indifferent, and inattentive, although rarely they have an agitated delirium related to ethanol withdrawal. If the disease is not treated, stupor, coma, and death may ensue. Ocular motor abnormalities include horizontal nystagmus on lateral gaze, lateral rectus palsy (usually bilateral), conjugate gaze palsies, and rarely ptosis. Gait ataxia probably results from a combination of polyneuropathy, cerebellar involvement, and vestibular paresis. The pupils are usually spared, but they may become miotic with advanced disease
1. Korsakoff's psychosis (Korsakoff's syndrome) presents as profound and persistent anterograde amnesia (inability to learn new material) and a milder retrograde amnesia. Additional symptoms can include impairment in visuospatial, abstract, and conceptual reasoning but with a normal intelligence quotient (IQ). Some patients demonstrate an acute onset of Korsakoff's syndrome in association with the neurologic stigmata seen with Wernicke's syndrome (e.g., sixth nerve palsy and ataxia), whereas others have a more gradual onset..
2. Ataxia, Nystagmus and lateral rectus weakness point towards Wernicke’s encephalopathy
3. In erotomania, the subject, usually a single woman, believes that an exalted person is in love with her. The supposed lover is usually inaccessible, as he is already married, or famous as an entertainer or public figure. According to De Clerambault, the infatuated woman believes that it is the supposed lover who first fell in love with her, and that he is more in love than she. She derives satisfaction and pride from this belief. She is convinced that the supposed lover cannot be a happy or complete person without her.
4. Delirium Tremens (DT) is the most severe alcohol withdrawal syndrome and it occurs when the patient has abstained from alcohol.
Read the relevant chapters on Alcoholic and other Addictive substances with special emphasis on the Toxicity as well as Withdrawal Symptoms
Questions like these which are straight and easy are nowadays very rare. Though this is a simple question, I have to warn you that if you come across a “simple looking” question in AIIMS and All India Question Paper, please read it a couple of times more. The chances are that there is a “trap” there

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