Figure 40-1. Clinical features of Wernicke-Korsakoff disease in a series of 131 autopsy proved cases. (Reprinted with permission from Harper CG, Giles M, Finlay-Jones R: J Neurol Neurosurg Psychiatry 49:341–345, 1986.)
Figure 40-2. Axial T1-postgadolinium image of a 63-year-old woman with Wernicke encephalopathy showing abnormal enhancement of the mammillary bodies (arrow).
Figure 40-3. Sagittal (left image) and axial (right image) T2 MRI of the cervical spine in subacute combined degeneration (SCD) showing abnormal hyperintensity in the posterior columns. The patient had markedly reduced vibration and position sense and a Romberg sign; the tendon reflexes were preserved and there were no corticospinal tract or peripheral nerve signs.
Figure 40-4. Axial CT from a 60-year-old alcoholic patient showing prominence of midline cerebellar sulci (upper image). A broad-based gait and ataxia of the legs had been present for many years. Death was from myocardial infarction. The cerebellum, cut in the midsagittal plane (lower image), shows folial atrophy of the anterosuperior vermis, characteristic of alcoholic cerebellar degeneration.
Chapter  40    Diseases of the Nervous System Caused by Nutritional Deficiency
Eye movementabnormalities (2.1%)Ataxia (1.0%)Confusion (34%)Confusion/ataxia(17.5%)Eye movementabnormalities/confusion (8.2%)Eye movementabnormalities/ataxia (2.1%)97 casesOne sign(37.1%)Two signs(27.8%)No signs(18.6%)Three signsClassic triad(16.5%)No signs(18.6%)One sign(37.1%)Two signs(27.8%)
Disorders of the Nervous System Caused by Alcohol, Drugs, Toxins, and Chemical Agents
Subsumed under this title is a diverse group of disorders of the nervous system that result from alcohol, drugs, and other injurious or poisonous substances. The neurologist must be concerned with the myriad of chemical agents that may adversely affect the nervous system; they abound in the environment as household products, insecticides, industrial solvents, and other poisons, as well as substances that may have therapeutic value but are used for their “recreational” psychotropic effects, or are conventional medications with known toxic effects. Also among the neurotoxins are those generated by bacteria and other infectious organisms, as well as toxins found in nature, such as marine toxins. Together, the effect of these agents and toxins on the nervous system constitutes the field of neurotoxicology.