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Images in Neurology |

Characteristic Neuroimaging Abnormalities of Korsakoff Syndrome ONLINE FIRST

J. Bradley Segal, BS, BA1; Marc A. Bouffard, MD1,2; Gottfried Schlaug, MD, PhD1,2
[+] Author Affiliations
1Harvard Medical School, Boston, Massachusetts
2Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Neurol. Published online August 29, 2016. doi:10.1001/jamaneurol.2016.1843
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This case report describes the clinical and neuroimaging manifestations of Korsakoff syndrome.

A man in his 70s with a history of chronically elevated lactate levels, alcoholic cirrhosis, and chronic cognitive decline attributed to hepatic encephalopathy despite lack of asterixis or response to lactulose presented with 1 week of confusion worsened from baseline. On examination, he had anterograde worse than retrograde memory deficits without asterixis, nystagmus, ophthalmoplegia, or ataxia. Findings on magnetic resonance imaging of the brain (Figure) were consistent with previously undiagnosed Korsakoff syndrome.1 His subacute decline was attributed to a urinary tract infection, and the patient’s orientation returned to baseline with antibiotics. His lactate level returned to within a normal range with parenteral thiamine, although his memory deficits persisted.

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Magnetic Resonance Imaging Findings of Korsakoff Syndrome

Magnetic resonance imaging shows bilateral fluid-attenuated inversion recovery hyperintensity (arrowheads) in the periaqueductal gray matter (A), mammillary bodies (B), and medial thalami (C). D, Sagittal T1-weighted image demonstrates volume loss in the corpus callosum (arrowhead) and in the cortex with widening of the cerebral sulci.

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