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A 57-year-old male who was
brought to the ER
unresponsive
Leonidas Arvanitis, M.D.
Neuropathology Fellow, PGY-6
History
• The patient was a 57 year old male who was
brought to ER due to unresponsiveness after
heavy drinking
• Lab tests showed severe metabolic acidosis (pH
of 7.01), acute pancreatitis and hepatic failure
• He was transferred to the ICU and was put on
pressors and fluids
• The patient further deteriorated, developed DIC
and died the next day
Autopsy
• An autopsy was performed and showed
the following (describe):
Autopsy
Bilateral mamillary body
hemorrhages
This is a section from the mamillary
bodies. What do you see?
Mamillary bodies. Click here for
H&E section
This is a section from the mamillary
bodies. What do you see?
This is a section from the mamillary
bodies. What do you see?
Bilateral mamillary bodies
showing multifocal confluent
hemorrhages
This is a section from the mamillary
bodies. What do you see?
Neurons do not show significant
hypoxic changes. No gliosis or
hemosiderin is identified.
Question:
• What is the most likely diagnosis?
Answer
• Acute Wernicke’s-type encephalopathy
Question:
• What is the cause of this disease?
Answer
• Thiamine deficiency