Teaching Neuro <i>Images</i> : Bilateral anterior thalami and fornix macrohemorrhage in Wernicke-Korsakoff syndrome

A 55-year-old man with alcoholism required sigmoid resection for complicated diverticulitis.A few weeks after starting parenteral nutrition, he developed multidirectional gaze nystagmus, gait ataxia, and confusion, leading to the diagnosis of Wernicke encephalopathy.Thiamine treatment was started and his symptoms improved, helping to confirm the diagnosis.However, the patient developed memory loss consistent with Korsakoff syndrome due to hemorrhage involving the fornix and the bilateral anterior thalami (figure).More typical fluid-attenuated inversion recovery lesions (mamillary bodies, tectal plate, and periaqueductal area), which may be reversible, 1 were not seen.Macroscopic hemorrhage is rarely observed in Wernicke-Korsakoff syndrome 2,3 and is associated with poor prognosis. 3