In the context of chronic alcohol use, which syndrome often presents with ataxia, ophthalmoplegia, and confusion?

• A. Wernicke encephalopathy
• B. Korsakoff syndrome
• C. Withdrawal
• D. Delirium tremens

Answer: (A)

In chronic alcohol use, thiamine (vitamin B1) deficiency can cause Wernicke encephalopathy, an acute brain disorder that presents with a classic triad: gait ataxia, eye movement abnormalities (ophthalmoplegia or nystagmus), and confusion. The eye and coordination problems arise from brainstem and cerebellar involvement, while the mental status changes reflect dysfunction in diencephalic and cortical areas. This condition is a medical emergency; prompt high-dose thiamine is essential to reverse symptoms and prevent progression to Korsakoff syndrome, which is a chronic memory disorder with amnesia and confabulation rather than the acute triad. The other syndromes—withdrawal and delirium tremens—feature different clinical pictures (tremors, autonomic symptoms, delirium) and do not consistently show the combination of ataxia, ophthalmoplegia, and confusion. Therefore the described syndrome is Wernicke encephalopathy.